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, APPLICATI� FOR CONSTRUC7'�N PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8610 <br /> f7 DEAi1JLITION f 1 COMBINATION I� BUILDING IyMECHANICAL f� PLUMBING (l SIGN <br /> PROJECT ADDRESS <br /> 90 M rz,ti , _ <br /> OWNER MFILr1�DRE5S Cltt :IP PIIONE <br /> MST�'ak�sak; � ��4 s wei�,- s-r ��+� �I8��1 ,�:a-4448' <br /> MAILADORF55 CIiY l�p i'��aNE <br /> ARCHITECTOROESIGNER MAILAD�RESS CITV IIP PIIONE <br /> GENERAI,CONTRACTOR MM�AODRE55 CITY )IP PIIONE <br /> C.w M� STATE LICENSE/ <br /> X�� ��l 195 OwI1.�1.✓ <br /> MECHpNICALCONTRACTOfi MAILADDRE55 CITY ZIP Pf10NE STATEUCENSE� <br /> Aj E��a-�i��TNC �n l�r�x 88y tiln .Iq 1��� Qgp¢S- 831 (a�ion AEt1E �� ��MA <br /> PLUMBINGCONiRACTOR MMLAODRE55 CITY Z�P PHONE <br /> STATE LICENSE� <br /> Cj1NTR�CT PRICE OF WOfiK <br /> a��I ZSo HEATING SYSTEM: GYGAS f7 EIECTRIC ❑ <br /> DESCRIBE WOqK AND SOUARE FOOTAGE INVOLVE� . CONTFCT PERSON AND PHONE NO. <br /> =N T 11 Gq +� Gp T GA E AlF �-b 00 <br /> '�6 r a T r A Co � Ekj1 A u S <br /> �u�T All NA T F 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TH�S <br /> PROPOSEO USE OF BUILOING APPLiCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORD�NANCES GOVERNING THIS TYPE OF <br /> LEGAlDESCRIPTIONOFPROPERTV�SHOWNBELOWORATfACNT\VOCOPIES� WORK WILL BE COMPL�ED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NJT PRESUME TO GIVE <br /> �ai BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER Sl'ATE 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 /> PARCELTA%I.D.NUMBER CONTRACTORS LAW 1027 RCW AND 2g6.200 WAC. <br /> CONSTRUGTION LORN LENDER.AD�f1E55.1ELEPHONE NUMBER x 1\_//.�n I .•�„ �/�� <br /> ilA�Xt [.l.u// <br /> SIGNATURE AT <br /> ozy 9Iz <br /> CITY BUSINESS IICENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF FI%TURE OR ITEM FEE <br /> WATERCLOSET(TOILET) � A/C—AMNOLGUNITS—H.P. � � <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.USUM E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER , ' <br /> UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS ' <br /> � <br /> DISHWASHER � VENTILATION FAN i <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER , <br /> _ URIIJAL ' WOOD STOVE � <br /> _ DRINKING FOUNTAIN i METAL rIREPLACE(WOOD BURNING) ' <br /> � <br /> FLOOR DRAIN ! FIFEPLACE I�SERT(WOOD BURNING) i <br /> BACKFLOW PREVENTERS ' GAS FIREPLACE � <br /> � � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE , <br /> ' � GAS PIPING l38(l Fve 1 cr ' <br /> � EXHAUST FAN ; <br /> i � <br /> � � <br /> � <br /> � � <br /> SUB TOTAL 5 ; SUB TOTAL S p ' <br /> � <br /> PERMIT S � PERMIT $ / , <br /> TOTAL FEE 5 � TOTAL PEE S '�� � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACN SIOE SETBALK PIAN CHECN NU�WfER FEE RECEIPi NO. <br /> �d.:,�8 <br /> USE ZONE LOTAfiEA VACANT SITE FEES VALUATION FEE <br /> fIYES fi NO pUILDING � <br /> i <br /> HEIGHTIIMITpTION NOOFDWEILIHC SREOFBLOGRI. � <br /> UNITS i <br /> PUIMOING i <br /> OCCUPANCV NO OFSI0RIE5 OCCUPANTLOAO BASEMEN� M[CM�NICAL � <br /> GPOUP <br /> C7YE5 f7 NO ' <br /> i <br /> FIRE ALAPM REO'D REFSON ADDITIONAL PLAN CHECK � <br /> i <br /> OTlIER � <br /> FIRE SPRINKLER PEO'D REFSON i <br /> STATE OUILDING SURCHARGE i <br /> 7YPEOFCONST PLr1N5APPPOVE�BV C�TYOFEVEREIT POAIICWOPNS � <br /> LOCAL SALES ' <br /> ontE TAX CODE IS 3105 70TAL I <br />