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APPLICATIO.� FOR CONSTRUC? .JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERL TT, WA 98201 •259-8810 <br /> 17 DEMOLITION I 1 COMBINATION �l BUILDING .�MECHANICAL y PLUMBING rl SIGN <br /> PROJECT ADDRESS / <br /> P �� � �- `/ � , <br /> OWNEH ' MAILq�DR[55 Cii' IiP PtiONE <br /> % % S/S�< �9 I� �v i�'//'�.f��l���3 3��-C/,�/ <br /> 1En�nNT Mn��qpon[ss c�r� n❑ vrwNE <br /> ��%C <br /> ARCNITFCTORDESIGNEP MRIL4p�RE55 Citt ZIP PIIONE <br /> GENE LG NTPP�T _ MA .ADO.�ESS ��IiV IiP ,IPMOV[ ST�TELICEN • <br /> ' ^�y f� � ���j <br /> � ' /� / � J / (V Cl ) /_"l <br /> MECNRNIG NTRACTOR MRILADIIR 5 C fV ^ZI PH N STATE LICE SE� <br /> i <br /> WA�BI4 C TR�CTOR MnILr1DDRE55 CILY 21P P110NE STAtF.tICENSE� <br /> CONT iCE OF WOfiK � <br /> ' � � HEATING SYSTEM: _i GAS Cl ELECTRIC ❑ <br /> DESC WO AND 50 RE FOOTAGE �O/LV/Ep CONTA�PEPSON AND PI NE NO <br /> //F ��C � U � , - 1 �� � O � / <br /> �/Y {��/ �L � � ' . <br /> ������f� 1 HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> v voseo use oF euaoir+ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEPEIN OR <br /> LEG�LpESCNIPTIONOFPROPERiY�SNOWNBF.LOWORATfACM7WOGOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> iot eiocK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTi�UCTION OR THE <br /> PERFORMANCE OF CONSTAUCTlON.TNAT I AM AUTHORIZED BV THE <br /> OWNER Of THIS PROPERTV TO PERFORM THE WORK FOR WH�CH <br /> APPLICATION IS MADE AND I C�PLY W!TH THE STATE <br /> PARCEL TAX I�.NUMBER CONTRACTORS LAN� . �Y AND ga 0 WAC. <br /> � �v �� <br /> CONSiRUCTIONLORN LEN�[R.ADDRESS.TELEPNONE NUMAER Z '� � � <br /> SIGNATUPE D�T <br /> LITY BUSINESS LICENSF NO <br /> PLUMBIN6 MECMANICAL <br /> NO. TYPE OF fll(TURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILF i) i A/C—A/HNDLG UNITS—H.P. T— <br /> BATHTUB � FORCED AIR SVSTEMS—B.T.U. M E.A. � <br /> IAVATORV(WASH BASIN) � HEAT PUMP <br /> SHOWER UNITHEATERS—B.T.L. M � <br /> KITCHEN SINK 8�ISP CLOTHES DRYERS � <br /> DISHWASHER VENTILA710N FAN � <br /> LAUNDRY TRAV RANGE HOOD � <br /> CLOTHES WASHER i WATEP HEATER <br /> URINAL WOOD STOVE � <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) <br /> FIOOR DRAIN � FIREPL'nCE INSERT(WOO�BURNING) � <br /> BACKFLOW PREVENTERS ; GASFIREPLACE ' <br /> SINK(SERVICE—BAR,ETt.) i GAS RANGE ' <br /> A! GAS PIPING <br /> i EXHAUST FAN i <br /> � i <br /> � i <br /> — � <br /> SUB?OTAL $ � SUBTOTAL $ U i � <br /> PERMIT $ � PERMIT $ /,j � � <br /> TOTAL FEE $ TOTAL FEE $ ' � <br /> FOR OFFICE USE ONLY: <br /> FRONT SF.TBpCK REAR SETAACK SIDE SETBACK PLAN f�HECK NUMBfB FEE HECEIPT N0. <br /> �/7�0(P <br /> USE ZONE LOT AREA VACRNi SITE FEES VALUATION FEE <br /> - flVES I� MO PUILOING i <br /> � <br /> NEIf,MT I.IAIITRTION NO O�OWEIIING SIZE OF BLDGrtI � ' <br /> IINIiS PLUMpING � <br /> GCCUPANCY NO 0[Si0aIf5 OCCUPANII.OPU BASEMENT � <br /> �ROUP MECIIRNICAL i <br /> flVES 11 NO <br /> i <br /> FlRE ALARM PEO'0 REASON ADOIPOYAI PLAN CHECK i <br /> i <br /> OTIIER i <br /> FIRE SPRINN�ER REO'O RE4S0Y <br /> � <br /> SiRTE OUIIOMG SURf,MfqG[ i <br /> 1 <br /> tme ur cor+sr riaas nr�noveo ev CITY OF EVERETT ruAuc wonKs � <br /> LOCAL SALES <br /> oqiE TAX CODE IS 3105 TO7AL I <br />