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APPLICA'�l'I�.N FOR CONSTRUCI �ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> ❑ DEMOLITION f 1 COMBINATION f l BUILDING yQ MECHANICAL fl PLUMBING fl SIGN <br /> PROJECTADDRESS <br /> `� �1 E. . Ma��tic �i�--..� l�r � :c <br /> OWNER MAILADORESS CITV <br /> I�� PIIONE <br /> J�.� 1 4��`.>�a��i i 3 � Z S_ �..IE�.�.-�R.- 'ST �c-+�T�a. ` F� 1<F4 <br /> TeNnNr Mnanqpness � ���w l 321� - `11'�-`� <br /> CIIY IIP PHONE <br /> I �l <br /> AFlCHITECTOqDES�GNER AIqILRDORESS ��ry <br /> Z�P PHONE <br /> GNA2�C�� Mo2GAN rA•S•_rw. -730 <br /> GENERA��ONTiipC70R MAILppDfiES$ 1 r}C~`�• �Y ���` Cv�£L�T� w� �a 20 j �y 3�ZFiQ� <br /> CI7Y ZIP PHONE STATELICENSE� <br /> �.� Ti>K ��SAK\ J.4+Mt= ✓t`-�� 2`-...J�JL-' M��'/ak 1 1 2�3GL` <br /> MECHANICALCONTRACiOR MAqADDPESS CIN <br /> 1�F PHONE 3-Q�`15TATE LICENSE� <br /> ����'-� �, --�c r�'i�-r�-r -r.,- r�5'o �543 wcnl��Nv���E WA ADJAN <br /> PLUMBINGCONTRACTOR MAI�ADDRE55 P ���� <br /> ��tt Z�P PHONE <br /> STATE LICENSE• <br /> CONiRACT PRICE OF WORN <br /> '�3 �oo _`g" HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> OESCRIBE WORN �ND SOUARE FOOTAGE INVOLVEO • LOYTACI PERSON AN�PHONE NO. <br /> �h1S�4l.�1�. �o l � ` _\tJ1Gl.'s^ .�/� � [�AN� <br /> � � <br /> iN 6u,..q„v�. 1 z f 3 - •�3- �a � <br /> �'� � ��t `'c�o�z ��n �a�x 3 �oUS � HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF 6UILUING . , PPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �t.'S� O`"v��T�/�,�._, C1'.�,���p�����V�,� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGRLDESCRIPTIONOFPROPERTV�SHOWNBELOWORATTAClIT1VOCOPIESI WORK WILL BE COMPLIED WITH WHETHER SPECIfIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ��T B��K 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 MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.D.NUMBER CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br /> CONSTRUCT10NlORNLENDER,ADDRESS.TEIEPHONENUMBER <br /> X <br /> SIGNATURE ORTE <br /> CITV BUSINE55 LICENSEi NO. <br /> PLUMBING MECHAN�CAL <br /> NO. TYPE OF fl7CTURE OR ITEM FEE N0. TYPE OF FIl(TURE OR ITEM FEE <br /> WATER CLOSET(TOILET) . � q/C—AMPIDLG UNITS—H.P. ��— <br /> BATHTUB i FORCED AIR SYSTEMS—B.'.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP <br /> SHOWER ' <br /> ' UNIT HEATFRS—B.T.U. M � <br /> KITCHEN SINK 8 DISP � CLOTHES DRVERS � <br /> DISHWASHER ' <br /> ' VENTILATION FAN � <br /> LAUNDRY 7RAY � RANGE HOUD � <br /> CLOTHES WASHER ' <br /> � WATER HEATEF , <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) ' <br /> FLOOR�RAIN ' <br /> ' FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR, ETC.) , ' <br /> GASRANGE , <br /> ; GAS PIPING � <br /> � EXHAUSTFAN , <br /> � <br /> � �_ <br /> � <br /> � <br /> SUB TOTAL $ ; SUB TOTAL S ' <br /> i <br /> PERMIT 5 � PERMIT 5 � <br /> TOTALFEE $ � TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONi SETBACN REAR SETBACN SI�E SEiBRCN PIAN CHECN NU BER / FEE / �Ji REGEIPT NO. <br /> 1`7/ <br /> USEZONE LOiAREA VACANTSITE FEES VALUATION FEE <br /> f7VE5 fi NO <br /> omioiNc , <br /> HEIGHTUMITATION NOOFOWELLING SIZEOFOIDGRi. � <br /> UNIiS <br /> PWM�ING i <br /> OCCUPANCY NO O�S70RIE5 OCCUPANTLOAO BRSEMEN� � <br /> GROUP MECNANICAL � <br /> ❑YES f7 NO � <br /> FIREALARMREO'0 REASON ADDITIONqLPLANCMECN � <br /> � <br /> OTHER � <br /> � � <br /> FIPE SPRINNLER REO'0 PEASON � <br /> STATEBUILDING URCNFRGE i <br /> TYPE OF CONST PlANS PP OVEO BY � <br /> 1�' CITYOFEVERETT ruoucwonKs ; <br /> LOCAL SALES .i— <br /> DATE /b ?5 TAX CODE IS 3105 TOTAL I <br />