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APPLICATIV�1 FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETf• BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION Cl COMBINATION f-1 BUILDING MECHANICAL rl PLUMBING C7 SIGN <br /> PROJECT ADDRESS �� l� � / `/� C�� .Q ��� <br /> o�f� �S'S�itlA��pC� /�O��n � c'//-�lee/��zm V �t1 v��or+e S, � Q <br /> �� E �� <br /> iENANT M�AO�SS CITY 21P PI10NE <br /> n <br /> ARCHITECT OR DESIGNER L ADDR 55 CITV ZIP PHONE <br /> GEt�{ERA{.COY��O� ��^^�ES� �D�� �T��/� J��' M/�A��E STATE LICENSE� <br /> I /�. I // //! `,m//�T /� 9�/99 2�'z -�1�0� <br /> /u l�lJ v� �7 vd-� C/ ✓/Y'%�� �.•-� i <br /> MECHANICALCONTR TOR MAILPDORESS CITY ZI�P� FI�ONE STATEIICEN E� <br /> ���� <br /> PLUMBIN6CONTR�TOR MAILADDRE55 Cltt ZIP PHONE STATELICENSE/ <br /> CONTRACiPRICEOFWORK • �O � HEATING SYSTEM: . . GAS ❑ ELECTRIC ❑ <br /> DESCRIBEWORKANOSOUARE TAGEINVOWED CONTACTPERSONANDPMONEN . a�� <br /> _ , � � �U� Q <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TtiIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPoSED USE OF BUILOING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS 7YPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN JR <br /> LEG�LDESCRIPTIIXJOFPROPERTY�SMOYMBEIOWORATTACNTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �pi BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MAD��O�I�.COMPLY WITH THE STATE <br /> PARCEI TAX I.O.NUMBEP CONTRACTORS LA t�7��CW AND�296200 WAC. <br /> � ✓ <br /> Q � " . � <br /> CONSTRUCTION LOAN LENDER,AODRE55.TELEPMONE NUMBER �( � � � <br /> SIGNATURE DATE <br /> � <br /> CIiY BUSINESS IICENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FUCTURE OR�TEM FEE <br /> WATER CLOSET(TOILET) � PJC—AMNDLG UNITS—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � <br /> LAVATORV(WASH BASIN) � HEAT PUMP ' <br /> SHOWER ' UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES DRVERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNORY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER ' <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BUFlNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE ' <br /> � i <br /> � GAS PIPING � <br /> , <br /> ; EXHAUSTFAN ' <br /> i <br /> i <br /> � <br /> � � <br /> � <br /> � ' <br /> SUB TOTAL 5 � SUB TOTAL S ; <br /> PERMIT S � PERMIT 5 � <br /> TOTAL FEE 5 ' TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACN AEAR SETOACK 9UE SETOACK PLAN CNE�UMjiE�� FEfi RECEIPi NO. <br /> p Ci <br /> USE 20NE LOT AREA VRCANT SITE FEES VALUATION FEE <br /> i <br /> fl YES ❑ NO OUILDING i <br /> NEIGXTLIMITATION NO.OFDW[LLINC. SREOFBLDGRI. � <br /> i <br /> UNITS P�IIMOING � <br /> OCCUPANCY NO OFS70RIE5 OCCUPANTLOAD BASEMENT � <br /> GROUP MECIIANICAI i <br /> ❑YES Il NO j <br /> fIREALAFMREO'0 �EASON ADOITIONTI.PLANCHECN � <br /> i <br /> OTNEN I <br /> FIRESPRINKLERREOD RE�SON I <br /> STATE O111L01NG SURLHARGE � <br /> TYPEOFCONST PLANSRPPROVEDBV CITYOFEVERETT �'�BLICWORKS i <br /> LOCAL SALES ; <br /> DATE TAX CODE IS 3105 TOTAL ' <br />