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APPLICAYI4.A FOR CONSTRUCT .a'N i�ERMIT <br /> CITY OF EVERETT• BI�ILDING DIVISION �eA���� <br /> 3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br /> I I DEMOLITION � i COMBINATION I I BUILDING I 1 MECHANICAL LUMBING f�l SIGN <br /> PROJECT ADDRESS �nr � � /�'f`" <br /> CY `7" <br /> OWN[R MAILA�ORE55 CITY ZIP PHONE <br /> , , � Slc�{/��G ��'��� J 2 S'�� <br /> TENnr+r Mnu.noonEss citv zm r�{o�+E <br /> MCIIITCGT OR DESIGNEH MAILAOp(iE55 GITV ZIP PHONE <br /> I <br /> GENERALCONTFIACTOR MPILADORESS CITV ZIP PHONE STATELICENSEx <br /> MECHANICAL CONTRAG70R MAILAD�RE55 CITY ZIP P�IONE STATE LICENSE M <br /> Pllll,101NGCONiRACTOR MAIL�UORESS CITY ZIP PHO�JE 5T4TELICENSEM <br /> � , � _ /�i'r�.� P�!4�t�� <br /> roNrnncraaicFOFwon� HEATING SYSTEM: Cl GAS fl ELECTRIC rl <br /> OFSCRIBE WORN AND SOUAPE FOOTAGE INVOLVED CO4TACT PERSON AtID PHONF N0. <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSED USE OF BUILOING PROVISIONS OF LAWS AND ORDINANCES GOVERIJING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LGGALOESCRIPTIONOFPflOPERiVISHOWNBELOWOflATTACHTY/OLOPIE51 NOT. THE GRANTING Of A PERMIT DOES NOT PRESUME TO GIVE <br /> ipr e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE.OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTFUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF 7HI5 PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS M11ADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1B27 RCW AND 296.200 WAC. <br /> PMCELTAAI.D.NUMBER <br /> CONSTFUCTION LOnN LENDER,�OORE55,1ELEPHONE NUMBER �( ��r /�� V ` � pA/€Q�. <br /> SIGNni fi[ <br /> � <br /> C13 4/m!-/ PL CiK�C-{f �.�t oueiv�ssucEra�eNo <br /> "' MECHANICAL <br /> PLUMBING <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. 7YPE OF FIXTURE OR ITEM �EE <br /> i WAiER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. _ ' <br /> — BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORV(WASH BASIN) � HEAT PU�1P ' <br /> ' SHOWER � UNIT HEATERS—B.T.U. M ' <br /> � ' CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � <br /> DISHWASHER � VENTILATION FAN � <br /> ' LAUNDRY TRAY � RANGE HOOD � <br /> — CLOTHES WASHER � WATER HEATER ' <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GASFIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE . � <br /> � GAS PIPING � <br /> ; EXHAUST FAN ' <br /> i <br /> i <br /> i <br /> � <br /> SUB TOTAL S ' SUB TOTAL S � <br /> PERMIT 5 � PERMIT S � <br /> TOTALFEE S ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SFiOnCN FGAR SET�ACK SIOL SETORCK PLAN CHECK���� FEE <br /> RECEIPT N0. <br /> FEES VALUATION FEE <br /> USEZONE LOTAfiEF V�C�NTSITE � <br /> i <br /> IIYES fl NO eUILOING ' <br /> S � <br /> HEIGNT UMITATION NO OF OWELIING SIZE OF BL�G�T.I. q � <br /> UNITS PLUU9ING O � <br /> i <br /> OCGUPFNCY NO OF Si0RIE5 OCCUPANT 104� BASEMENT MECMANICAL � _ <br /> GROUP � <br /> ❑YES fl NO � <br /> A�OITIONAL PLAN CHECK � <br /> FlPEALARMREO'O REASON <br /> i <br /> i <br /> OTHER � <br /> FlRE SPRINKIER REO'Il PEn50N 1 <br /> i <br /> STAT[t1UIL01NG Sl1iiCHA(iGE i <br /> TYPEOFCONST. PIANS�PPROVEDBV CITY OF EVEAETT Pl1ALICYJORKS � <br /> LOCALSALES ; � <br /> onTe TAX CODE IS 3105 TOTAL <br /> r�� <br />