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APPLICATIOrI FOR CONSTRUCTIdN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> I-7 DEMOLITION f� COMBINATION fl BUILDING MECHANICAL �PLUMBING f l SIGN <br /> PROJECT ADDRESS �p- q ''" <br /> '� ' - - Sw = �C c' / - ' <br /> ON?!ER M�ILpC�ORESS CITY ZIP PH N[ <br /> /�J,Tc.j/ �' S;- s' �c�' Ci��,,,�.��>s ��� . r��r� �'i �.�9�'�i� 3 >'%' `�%3� <br /> iEN�NT Q MqLA00RF55 CITY ZIP PNONE <br /> ,/f�/!7G <br /> ARCHITECTOR�ESIGNER MAILADDRE55 CItV 7.IP PNONE <br /> GENERALCONiRPCTOR MRILAODRE55 CI1V zIP PHONE SGTELICENSE� <br /> IIORl}IWEST WATER NEAppT�E�R}. ING .14,� ���on ,i-i�/l,�//�io�l<'a- <br /> ME `CMMINM��NfiIKE A''O�.AOGJI ��N ZIP PHONE STATELICENS • <br /> �ll <br /> �.� <br /> PLL1M91N A. AILADDRE55 CITY ZIP PHONE STATELICENSE• <br /> CONTR�Ci PRICE OF WOPK <br /> — HEATING &YSTEM: GAS �I ELECTRIC f-1 <br /> DESCRIBE WOHK�ND SOVAR FOOTA E INVOLVEO CONTRCT PERSON ANO PHONE NO <br /> , , - �.�F= /,��6�,� �,�-��y��f <br /> /'i/�c ' /�Gu/7 f rG;C'ti9Cr <br /> � J i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> P SEDU. OF BUILDI G PpOVISIONS OF lAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRIPiIIXiOFPROPERTY�SHOWNBELOWORATfRCNTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT .BIOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERFURMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BV THE <br /> OWNER OF THIS PRO?ERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS M E�AND CO Y WITH THE STATE <br /> PARCEL T�7(1.0.NUMBER CONTRACTORS LA 827 R 200 AC. <br /> 4��Jf-oao -UG3-1�0�� <br /> CONSTRUCTIONIOANLENOER.�ODRESS.TELEPHONENUMBER X <br /> SIGNATURE E <br /> qTV BUSINE55 LICENSE NO. <br /> . PLUMBING MECHANICAL <br /> NO. TYPE OF Fll(TURE OR ITEM FEE NO. TVPE OF EaUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—FVHNDLGUNRS—H.P. ' <br /> ' BATHTUB � FORCEDAIRSYSTEMS—O.T.0 E.A. i <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES W'4SHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ; <br /> DRINKING F�iUNTAIN i METAL FIREPLACE(WOOD BURNIIlG) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE _ i <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE ' <br /> GAS PIP7JG � � ' <br /> i EXHAUSTFAN � <br /> i <br /> � ' <br /> � ' <br /> P,UB TOTAL $ ; SUB TOTAL $ ; <br /> PERMIT $ � PERMIT $ � � <br /> TOTAL FEE $ � TOTAL FEE S S`-. ' <br /> FOR OFFICE USE ONLY: <br /> FNONT SETPACK RE/R SFTBALN SIDE SETBRCN PUN CIIECK NUMBFfI � FEF RELEIPT N0. <br /> �OOL�`- <br /> USE ZONE LOT RREA VACANi SITE FEES VALUATION FEE <br /> fIYES fi NO i <br /> 6!11lDING i <br /> HEIGHT LIMITFTION NO.OF DWELLING $IZE OF BLD(iRA � <br /> i <br /> UNIiS PLUMBING _ __ � <br /> i <br /> OCCl/P�NCY NO Ot 510a1E5 OCCUPANT LOAO BASEMENT MF.CHANiCAL i <br /> GROUP <br /> I1YE5 �1 NO � <br /> FIRE RLARM REOD RFASOY AO��110NAL PLAN C�IF.CN <br /> i <br /> OTIIER <br /> FIRESPRINNIERREO� RE�FON <br /> SiNL BUILDING SUlIf,H4RGE � <br /> TVPF.OFf,ONST PI�NSnPPROVFDBY CITVOFEVERETT �11AlICWORKS _1__ <br /> LOCAL SALES ; <br /> �ArE TAX CODE IS 3105 7oTAl ' <br />