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APPLICATI�,.� FOR CONSTRUC7 ON PERM1� <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> O DEMOLITION fl COMBINATION f>� BUILDING fl MECHANICAL fl PLUMBING I-1 SIGN <br /> PROJECT ADDRESS � �� <br /> �l�0 1�'AGI'�IG AV�h1U� �v��"r <br /> OWNER MAILRD�RESS CITY ZiP PHONE �"r� <br /> f9�eoJt�f,�G�./laENE+l�AL M�.AI. G�J-4TEte,°�Iro t"J�GIF�G AY�JJUE,�V�T'I' 98�,(yp � <br /> teNnNr Mm�nooaess cm na PHUNE �„Z'tj <br /> �„"'�-�:�/6�`I�l6RAL MLbfC�(r�JT� °Jl�o f�GIF{G A�.113E EV�'"iT �gj�. <br /> A11p/1TCCTORUES�GNER NRILAD�RE55 GITY Zln PMONE �f,. � <br /> l�t3T��t'1,1-lAGiH s NAU. A1�a-f� 42['Xo HO'r'(' AV�. �V�e�T'� 982.�� <br /> GENEH/.LCO�NTRACTOR MAILADDRE55 CRV 7JP PIIOYE n�TATELICENSE� <br /> ��IC` lyllCp�� MRILA�DRE55 ' I�'�CI��� ��•!�v= p110� ���qELICEN9E��r�d <br /> PLUMBI pU0RE55 CITY 11P PIIONE STATELICENSE� <br /> CONTR�CT FRICE OF NqRI( ' <br /> +� 8d Q'Y.�.G17 HEATING SYSTEM: ❑GAS ❑ELECTRIC fl <br /> OESCIi1BE VIORK 11ND SOU�RE FOOTAGE�NVOLVED LONTACT P[RSONANO PHONE N0. <br /> �.�11� � <br /> � �� . � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPpSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.AlL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF ' <br /> WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�LDE CRIPTIONOFPROPERTY�SNOWNBEIOWORATTAGIITWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GNE <br /> �or e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PRO6'ISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> PERFOP.MANCE OF CONSTRUCTION.THAT 1 AM AUTHORRED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAq�ELtAKID.NUMOER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER.ADDRE55.TELEPHONE NUMBER � �� �e1 <br /> v <br /> sic;rvnrune � - onre <br /> 1�'7rv2 <br /> CITV BUSMESS LICEYS[NO. <br /> PlUMe1N0 MECNANICAL <br /> NO. TYPE OF FlI(TURE OR ITEM FEE NO. TVPE OF FIXTURE OR ITEM FEE <br /> • WATER CLOSEt(TOILET) � A/C—AMNDIG UNITS—H.P. � <br /> BATHTUB ' FORCEDAIRSYSTEMS—B.T.U. M E.A. ' <br /> � � <br /> LAVATORY(WASH BASIN) � HEAT PUMP —� <br /> . � <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 6 DISP � CLOTHES DRVERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRV TRAY ; qANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER , <br /> URINAL ' WOOD STOVE <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) ; <br /> FLOOR DRAIN � FIREPLACt INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GASFIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE , <br /> � GAS PIPING � <br /> � EXHAUST FAN ' <br /> � <br /> � —�— <br /> � , <br /> � , <br /> � � <br /> SUB TOTAL $ ; SUB T01AL 3 � <br /> PERMIT $ � PERMIT 5 , <br /> TOTAL FEE $ � TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBRCK PEAR SETBACN SIDE SETBACN P�AN CII[CN NUMOf:A F[E RECEIPT NO. <br /> usezoNe tor�aea vncnNrsite FE�/ VALUATION FEE <br /> nres n r+o <br /> om�oiNc ' <br /> � <br /> HEIGMT I.IMITATION NO OF DWELLING SIZE OP OLDG/tl <br /> UNITS <br /> I Q S J f'IUMBINu - �J�� �� <br /> G�iOUPpNCV NO 01 SI FIES OCCUPq�LO/.D OPSEMENI b1ECMANICAI i <br /> �1 � �7VE5 �O � <br /> � <br /> FIRE�URM R'c0'D REASOH A�D�TIONAL PUN CHECK � <br /> �`�Sn, ' <br /> on�En I <br /> FIRE SPRINKLER RF.O'0 P[ASON <br /> � <br /> R.STI�. STdTE AUILDING SURCHAAGE ���/� <br /> // <br /> TYPEOFCONST. PLANSAP OyEOBr CITYOFEVERETT PUBIJCWOiiKS I <br /> � LOCAL SALES <br /> onTe ' o�9S TAX CODE IS 3105 TOTAL '� � <br /> � — <br />