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e.-�i f _.y <br /> APPLICATIG.+1 FOR CONSTFiIlCT .ON PERMIT <br /> CITY OF EVERETT• BUILDI�IG DIVISION <br /> 3200 CEDAR STREET• EVEP.ETT, WA 98201 •259-8810 <br /> I� DEMOLITION � COMBINATION I ! BU!LDING fl MECHANICAL i�LUMBING �I SIGN <br /> PROJECT ADDRESS TM <br /> CaG�/ �/O �L, C.JG2�T'T <br /> OWNER IdAILA�DRE55 �Itt 71P PH0�1E <br /> k�r}u,y /�o.uES 33/� r�u��a,l k�lE e �ioo SE�rr�-c� 9s�/o�- �ag- 3»O <br /> TENANT MAILAD�RE55 GIN ZIP PNOYE <br /> ARCHITECTORUESIGNER MAILAO�RESS CITV ZIP PHONE <br /> GENERALCONTqqCTOR M41LApDRE55 CITV llP PMONE STATELICENSE+ <br /> MECHANICALCONTRACTOR MFILAD�FESS QiV ZIP PHONE STATEI.ICENSE+ <br /> PWMBINGCONTPACTOR MAILADDRESS QTV ZIP vHONE STATELICENSEr <br /> P,ac,F�e �o�xn�gr �.� a ie�c. Po Rox S,�a39 �e.e 4�so g 3•ass QACZF'aP�I�YC� <br /> CUNTRACT PRICE OF WORK <br /> HEATING SYSTEM: l 1 GAS �I ELECTRIC rl <br /> DESCPIDE WORK AND SOUAFE FOOT�GE INVOLVED f,OtJTACT PERSON AND PHONE N0. <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PfiOPOSED USE OF BIlIL01N3 APPLICATION P.ND KNOW THE SAME TO BE TRUE AND CORRECT.ALL , <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIEG WITH WHETHEP SPECIFIED HEREIN OR <br /> LEGFlDESCPIPTIONOFPROPERTV(SHOWNPELOWORATTACHNf000AlE5� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> i.or BLOCK oF AU7HORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTICN.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 /> PAqCELTA%I.D.NU6IBER CONTRACTORS LAW 1U27 RCW AND 296200 WAC. <br /> CONETRlICT10N LOhN LEN�EF.A�DRESS.TEIEPHONE NUI.I�ER X � /O/6�yS�' <br /> SIG TUPE �ATE <br /> oas7'7o�— <br /> CIiV BUSWESS LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � � <br /> BATHTUB � FORCED AiR SYSTEMS—B.T.U. M E.A. ; <br /> 5 LAVATORY(WASIi 6ASIN) i HEAT PUMP i <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> / KII�CHEN SINK 8 DISP � CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FA� � <br /> LAUNDRY THAY � RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL WOOD STOVE ' <br /> DR�NKING FOI�NTAIN ; ME7AL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GASFIREPLACE ; <br /> SINK(SERVICE—BAR, ETC.) � GAS RANGE <br /> � GAS PIPING ' <br /> i EXHAUST FAN i <br /> � i <br /> i i <br /> SUB TOTAL 5 p ;pp SUB TOTAI 5 ; <br /> PERMIT S p�pD PERMIT S � <br /> l'OTAL FEE S TOTAL FEE 5 ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACN RE0.R SETBACK SIDE SETBACK PLAN CIIECH NUMOER FEE PECEIPT NO. <br /> usEZorve �o7anEp VACANTSITE FEES VALUATION FEE <br /> nvEs n No pUILDWG I <br /> � <br /> HEIGHTLINITATION NO OFOWELLING SIZEOFBLDGRI. <br /> UNIiS <br /> PLUMpING <br /> GCCUPANCY NO OFS70FIES OCCUPANTLOAD 9q5EMENi <br /> GROUP MEGHANICAL � <br /> ❑VES fl NO � <br /> FIREALAflMREO'0 RE�SON AODITIONALPLANCHECK � <br /> OTIIER � <br /> FIRE SPPINNLER REO'0 REASON � <br /> STFTE BUILOING SURCHARGE i <br /> �VPEOFCONST PIANSAPPROVE09V CITYOFEVERETT PUBI.ICWORKS � <br /> LOCAL SALES <br /> onre TAX CODE IS 3705 TOTAL I <br /> � t.z <br /> � .. :r .. . . .5`�vwc� <br /> �" t Yera�Ft+�+t ea�t9P'�`��3s!``t'�*'..�e.i .. ,. 'b`�+e"sq`a�Ft�S-�S.K�4, : ��a r, : �-. � <br /> *1�r a.w�.4xe5'�7H�y'r'�'-..i°7��6"s-`.s-y's+�;,yyopyn � �' � : � ...�i..�..Y�2�kei1' .J}'nq RF? <br /> 4(l-:a�h w +..ur-av�iwc�aFbtlt^'�"'"tm�.1Y�.tam.�.a�4'�1.Tr'� �.v`�i�'sy�....i�,-:.: 2+.c.fi-u.,�;rv . . ;'u�?v,r <br /> 1�.�- � }IAIu�� Y�F_ � �-'V'J'!�r �.17 .•��' �."l.� £Ka3.s.�vn-'c Cc)'^�.'ndTc-lJ �. <br /> t �, <br /> .. I�+ <br /> C�.'+..� } ' ' <br /> r� ,..:_!'� �r '^+ fi✓'�� ." N:Y'Y�`� ��h_� .. � •:R <br /> �i <br /> ��. � ._ 4 . . .. <br /> ._..i . �.� .... ...:.a.. �w....�. <br /> �" ��i � . .. ���� �..���-._�-' R."Ji.� ,^'1'• . .. ^.ti �a <br /> � _.. � .� ..a�.........� . \. ... . . <br />