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�� i� <br /> APPLICATIO� FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 • 259-8810 <br /> ❑ DEMOLITION �l COMBINATION fl BUILDING � MECHANICAL �l PLUMBING rl SIGN <br /> PROJECT ADDHESS <br /> OWNER MRILAODRE55 Cltt 21P PHONE <br /> m«� .5+�4,af��J scioa a4 �' ,�v s� ��u�-h- tika�� 34�5 - 57�1a ' <br /> 7ENA T MRILA�DRESS CITY zlP FHONE <br /> S G!`�C'_ <br /> ARCHITECTOfi�E51GNER MRILAOORESS �ITY 71P PMONF. <br /> GENERALCONTRACTOR MRILA[IORESS CITY 21P PIIONF SiATELICENSE+ <br /> MECHANICRLCONTRACTOR MAILADDFESS CITV 21P PIIONE STATEUCF.NSE• <br /> PLUMBINGCONTRAf,iOR MAIIADDRE55 CITY ZIP pHONE STATELICENSE� <br /> U�cv a ll��e_ pI�M�+,�S IkBuo �ti.J'/ 5 i � � nwvo�� S�f�,3� '-L4L4 fl` NI{�lu))C�J <br /> CO RRCT PqICE OF WORK � <br /> � �5�1.+ —n �+ ' m� f- HEATING SYSTEM: f I GAS fl ELECTRIC rl <br /> DESCRIBE WORK ANO SOUFRE FOOTRGE INVOWE� CONTACT PERSON AND PHONE NO <br /> I n 4 I , ,cs �, �c. TZ /1C iJ c <br /> r� <br /> I HEREBY CEiiTlh�'+ THA7 I HAVE READ AND E%AMINED THIS <br /> PROPOSEDUSE OF 6UILDING APPLICATION AND Kh7'N THE SAME TO BE TRUE AND CORREC f ALL � <br /> PROVISIONS OF LAWS AND OPDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGRLDESGRIPiIONOFPROPERTV�SHOWNBELOWORATfACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT� BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PRUPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTAX I.D.NUMBER CONT ACTORS LAW 1827 RCW AND 296200 WAC. <br /> 9i� ��� � va ' <br /> CONSiRUCTiON LORN IENDER.AODRE55.TELEPHONE NUMBER x I I S / <br /> SIGNAT E pATE <br /> CITY BU INESS LICENSE NO. <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. 7YPE OF ECUIPMENT FEE <br /> � WATERCLOSET(TOILET) � A/C—AMNDLGUNITS—H.P. �— <br /> BATHTUB ; FORC'cD AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEA?EFS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS ' <br /> i <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) �r— <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE T— <br /> ' GAS PIPING ; <br /> � ERHAUST FAN � <br /> ---•— <br /> � � <br /> � — � <br /> SUB TOTAL $ ; SUB TOTAL $ ' <br /> PERMIT $ � PERMIT S � <br /> TOTAL FEE $ � TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETPACN REAR SFTBACK SI�E SETBACN PIAN CIIFCN NUMAF.R FEF RECEIPT NO. <br /> � <br /> USE ZONE IOT AREA VRCAN7 SIiE FEES VAIUATION FEE <br /> fIVES f1 NU BULL�ING i <br /> i <br /> HEIGHTLIM17ATION NO.OFDWELLING SIZEOFBIDGRI <br /> UN17$ pLpNf1WG <br /> —T <br /> OCCUPRNCV NO OPSIORIES OCCUPANTLOAD BASEMENT MECHaNIC�I � <br /> CROUV <br /> (IYES II NO — - <br /> FIRE AURM REO'D RF.ASON <br /> 40DIIlOun1.PI AN CNGCN <br /> Oi11Eli <br /> FIRESPRINKI.ERREOp PFASON — <br /> STAIE�UILDRIG SIIf1G114qGE <br /> i <br /> TYPEOPf,pNST {�IANSAPPROVEDBV CITYOFEVERETT <br /> PIIPIIf,WOqKS <br /> LOCAL SALES - — --'— <br /> uarE TAX CODE IS 3105 TOTAL ', <br />