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APPLICATII..dI FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> ❑ DEIYIOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS <br /> l�o/ � c % �c , C✓,2 ? Z� <br /> EfG�F' )'r • C.�L/a/R /Zo� %�%�C/F/G .//I/����jf'9 2°� ��9 �/�CQC/r <br /> TEN�HT MIULADWiE5�5 CITV ZIP PNONE <br /> �f{,a��' <br /> �RCNITECT OR OESIGNER MIU1.110�HES5 CITY ZIP PIIONE <br /> CaEyIERI�LCON GTOR I M�I'11DDRE55 CITV � 1/0 STATE UCENSE/ <br /> p�{ uL � - Ob ' �� '�.i�P O <br /> MECNAN.;�I ACTpi MAI�AWRESS CITV z17 � /_ �. J/f TELILENSE� <br /> Z�ll� �- Z i ��0 <br /> PLUMlM6CONTRACTpi MRILADOAESS CITV ZIP -PHONE STATEUCENSEII <br /> ��T�� 5- — <br /> MEATING SYSTEM: GAS O ELECTRIC ❑ <br /> oFScw�wor+ic�Nosau��root�mvav¢o CONTACTPERSONANDGHONE O. I � <br /> L <br /> �- C� r.uN BF ��A � Z Z-��-�oa <br /> I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> moroseo use a eimnma APPLICATION AND KNOW THE SAME TO BE TAUE AND CORPECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED MEREIN pR <br /> LECIU.DESCRIPTqNOFPROPERiY($�pWNEELOWOHATt�LNTWOCORES� NOT. THE 6RANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ioT e�oc�c o� �UTHORITV TO VIOIAT[ OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL UW REODUTINO CONSTRUCI"ION OR THE <br /> PERFORMANCE OF CANSfRUCTION.THl1T 1 AM AUTHOfiIZED BV THE <br /> ONRJER OF THIS PROP PERFORM THE WOpK FOR WHICH <br /> APPIICATION IS I COMPLV WITH THE STATE <br /> pIWCE�TA%�pM11,lEEq , I � �� �2� D+� v�! CONTRACTORS . 7R 200WAC. <br /> y , � <br /> CONSIRUCTON IO�N LENDER,1100RES5,7ELE MAIBF9 x <br /> SIONATURE 0 <br /> CITY BU&NE55 LICFNSE N0. <br /> PLUMSMIO MECMANICAL <br /> NO. irPE OF FlIITUIIE Op ITEM FEE NO. TYPE OF FlI(TUNE 011 ITEM PEE <br /> _ WATER CLOSET(TOILEI) � A/C—MiNDLG UNITS—H.P. � <br /> '3ATH1U9 ' FORCED AIR SVSTEMS—B.T.U. M E.A. ' <br /> LAVATORV(WASH BASIN) � HEAT PUMP � <br /> • <br /> SFIOWEA ' UNIT HEATERS—B.T.U. M � <br /> KITCMEN SINK 6 DISP i CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN �— <br /> LAUNDRY?RI1V ; RANGE HOOD ' <br /> CLOTHES WASHER � WATEH HEATER � <br /> URINAL ' WOOD STOVE <br /> DRINKINO FOUNTAIN � METAL FIREPUCE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPUCE INSEFT(WOOD BURNIN(i) � <br /> BACKFLOW PREVENTERS � OASFIREPLACE ' <br /> — � <br /> SINK(SERVICE—BAR,ETC.) � OAS RAN6E <br /> ' OAS PIPINO ' <br /> � E%HAUST FAN i <br /> � � <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL S ' SUB TOTAL S � <br /> PERMIT S � PERMIT S � <br /> TpTAL FEE S � TOTAL FEE f ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETARCK qEAR SETBACN SIDE SETB�CN PI i•'!CHECK NUMBER FEE RECEIPT N0. <br /> rZ <br /> usezor� LOTIIRE� v�caNrsirE FEES VALUATION FEE <br /> ❑res n r+o ew�oiNa � <br /> MEIONT UMIT�TION NO OF piYELLING SIZE OF BLIXiR.i. � <br /> UNITS P�UMBING i <br /> OCCUPANCY NOA�STOH�ES OCCUPANTIOAU B�SEMENT MECN�NICAL i <br /> GROUP <br /> ❑YES ❑ NO � <br /> FIRE�IARMREO'D qEA50N �DDITION�IPUNCHECK � <br /> i <br /> i <br /> OTNER � <br /> FIPE SMIINKLER PEO'0 REASON � <br /> STATE BUIIDING SURCHAFGE i <br /> TYPE OF COM1ST PLANS RPPROVED BY CITY OF EVERETT PII9LIC WORKS � <br /> LOCAISALEB , <br /> DATE TAX CODE IS 3105 TOTAL ; <br />