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APPLICATIO.� FOR CONSTRUCT.JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CCDAR STREET• EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION f-1 COMBINATION rl BUILDING � MECHANICAL f 1 PIUMBING fl SIGN <br /> PROJECT ADDRESS r <br /> � ��� �v� t' �L �JG <br /> OVRlER M�IL �RE55 p CITV ZIP PHONE I.� �_ ZZCJ.�?'. 4 <br /> �1QLJT ►�Jt1��FSi Rl� �K — DFa�1�C PA.cOw^2TF�. �,�J� �x 3 I��C�.TIIFNn o� <br /> TENANT MFILR�DRE55 GITV ZIP P ONE � � <br /> ����.-s Leu� U��,�— � '�Z (� �F� �/G �-�-�r-r- —aSZ—f�'31 '� <br /> AACHITEC RDESIGNER MML/�DORE55 GITv 21P � PMONE <br /> GENERALCONTRACTOR MAILRDDRE55 Cltt 21P PNON! STATELICENSE• <br /> � �,��'t".,e ,y9s <br /> M�,� �,�n M�wE.� s6r.+/i�E -1,0"1 o�r1R.o,r �,,s ,Ti.r ,er o n,��i.1.,MI.�. <br /> MECH�NIC�LCONTRACTOR MAIIADDRE55 CITV 21P PHONE STATEIICENSE� <br /> PLUMBMGCONTR�CTOP MAILADDRESS CITV ZIP PHONE ST�TELICENSE� <br /> '�CT PRICE OF M'Oj�K <br /> ��i�7U HEATING SYSTEM: ❑GAS ❑ELECTRIC <br /> RIBE K�NOSQUAREPOOT�GEINVOLVED CONT� TPERSONANDPHONENO. <br /> ( L � T `• <br /> N .� �,.� 3 '1�o') —�"1 �15 <br /> i HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> � ✓ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> rnoroseo us oF eua Na PROVISIONS OF LAN'S AND ORDINANCES GOVERNIN6 THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRIPTIONOFPROPERTY�SHOWNBEIOWOflATf�CHTWOCOPiES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT e�ocK oF AUTHORITY TO VIOIATE OR CANCEL TH� PROVISION OF ANY <br /> OTHER STATE OR IOCAL LAW REGULATIN(3 CONS?RUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.?HAT I AM 11UTHORIZED BY THF. <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTiVI I.D.NUMBEP CONTRACTORS LAW 1827 RCW AND 298200 WAC. <br /> CONSiRUCT10N LOAN LENDER.ADDRE55,TEIEPNONE NUMBEl1 x �� `� _`�� � <br /> SIG 1UR D E <br /> ICIiY BUSINE55 i ICENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FlICTURE OR ITEM FEE NO. TYPE OF FlIITURE OR ITEM FEE <br /> WATER CLOBET(TOILET) � AIC—A/HNDIG UNITS—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � �- HEAT'UMP ' _ <br /> SHOWER ' UNITHEi.?ERS—B.T.U. M � _ <br /> KITCHEN SINK 6 DISP � CLOTHES DRVERS T <br /> DISHWASHER � VENTILATION FAN _ : <br /> � <br /> LAUNORYTRAY i RANGEHOOD _T <br /> CLOTHES WASHER � WATER HEATER ! <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAM � FIREPLACE INSERT(WOOD BURNING) ' <br /> ' GAS FIREPLACE � <br /> BACKFLOW PREVENTERS � <br /> S�NK(SERVICE—BAR.ETC.) GAS RANGE ' <br /> GAS PIPING � <br /> � EXHAUST FAN ' <br /> � <br /> � <br /> � � <br /> � <br /> SUB TOTAL S ; SUB TOTAL $ TJ i � <br /> PERMIT $ � PERMIT $ 5� ' <br /> TOTAL FEE $ ' TOTAL FEE S � 5 ' ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSEiBRCK REARSETBACN SIDESETbALN PLANLNEC UMB�1i fEE RECEIPTNO. <br /> ��7,r� <br /> use ior+e �or nne� vrtnrvr siTE FEE9 VALUATON FEE <br /> nres n r+o � <br /> BUILOING � <br /> HEIGHTLIMITATION NOOFOWELLING SIZEOFBIDGR.�. � <br /> i <br /> UNITS PWMBING . <br /> i <br /> OCCUPANCY NO OFSTORIES OCCUPANTLOAO BASEMENT MECHANICAL � <br /> GROUP ❑y�5 rl NO i <br /> AD�ITION�L PLAN CHECK � <br /> FIFE�URMREOD RE�SON <br /> i <br /> OTHER ' <br /> � <br /> FIFE SPPINNLEN REOD AEpSON � <br /> STATE BUIIDING SURCM�RGE j <br /> TYPEOFCONST PIANSA� ��EDBV CITYOFEVERETT �'UBLICWORKS � <br /> �r. � LOCAL SA1.ES I <br /> o�r -S TAX CODE IS 3105 TOTAL ' <br />