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APPLICATII.��1 FOR CONSTRUC7 .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOUTION f.S7 COMBINATION ❑ BUILDING Cl MECHANICAL 17 PLUMBING ❑ SIGN <br /> PROJECT ADDRESS 3��-7 � �f`- �� <br /> ��yryEq MAILAOOHE55 CITY ZIP PMONE � <br /> C/11-�/��E N�CIYI�H 213i N�!-ti ���nA�t F����r-�'s 9$w � L5t-� r�� . <br /> TENANT MAILADC9ESS GITY ZIP PHONE <br /> pRLHITECTORDE5IGNER MAILADDRE55 CITY ZIP PHONE , <br /> A/r�:r3/lG�i �^'�"�� <br /> GENERALCONTflACTOR MAILAODFESS CIIV ZIP �HONE �SJT�AT�EJ�LICENSE� <br /> t La L- � Y �G N`1LlYlC ,� Z'1GC"/ <br /> I^��}�/j/l�ff �%Or sT 21 3'� �'llL(f�ih-O ,`Fc� C�i=�lc)7- 1 Lc�i ) � <br /> MECHANICALCONiAACTOR MAILA�DRESS CITY ZIP PHONE STATELICENSEt <br /> PLUMBING CONTRACTOR MAILAUDRESS CITV ZIP PHONE SiATE IICENSE N <br /> DA�If `s �(�1.'�ic � Yli T hr� E = 2.,� y_292� o,v °s i � i3 <br /> CONTRACTPRICEOFWO HEATING SYSTEM: ❑ GAS CA'ELECTRIC ❑ <br /> OESCRIBE��AGE INVOWED CONTACT PERSON AN�PHONE NO. <br /> i w F 2 S4 NL�F' irf�! i �r (-'�r ��,-n. w �.q Nw� �f'��G ..' �tc/1 c Z.i� -)ySo <br /> k ?f r�Gw nwRr Nut- w�rno,,s S H� c-1/-�' �H <br /> / � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> KEP�i( S h I J D F�H N�"� �I�t sU t -,'1R '��I4 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSED U E OF BUILDING %f PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> '���vF WORK WILL BE COMPLIED WITH WHETHER SPECIF�ED HEREIN OR ' <br /> LEGALOESCRIPTIONOFPROPERTY�SHOWNBELOWORATfACMTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �pT s�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> p � (,o j � � 7 `�y�((� yc J�f.G�,( SU OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> j1.�:'�7' 6 C� � �� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> V N�dY T�'''� ��/�•�5"S F�f-��� DO i�r' APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> n CONTRACTORS LAW 1827 FCW AND 296200 WAC. <br /> PARCELTA%IC.'D.ZUMBER' J� O I '/ O Ll. <br /> O � � ��v ����,( 5- 1 i� � <br /> CONSTRUCTION LOPN LENDER.PDDRE55.TELEPHONE NUMBER X <br /> �.` SIGNATURE DATE <br /> r�� <br /> � CITY BUSINESS LICENSE NO. 3 j <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> I WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. ! <br /> � FORCFD AIR SYSTEMS—B.T.U. M E.A. ' <br /> BATHTUB � � � <br /> LAVATORY(W,1SH BASIN) � HEAT PUMP ' <br /> SHOWER ' UNITHEATERS—B.T.U. M ' <br /> � <br /> KITCHEN SINK&DISP � CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> / CLOTHES WASHER � WATER HEATER � <br />� URINAL ' WOOD STOVE <br /> � � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNINGj ' <br /> i <br /> BACKFLOW PREVENTERS ; GASFIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE ' <br /> � GAS PIPING � <br /> ; EXHAUSTFAN ' <br /> � <br /> � <br /> i <br /> i � <br /> � <br /> i <br /> i <br /> SUB TOTAL $ ' SUB TOTAL $ ; <br /> � <br /> PERMIT $ PEPMIT $ � <br /> TOTALFEE $ � TOTALFEE $ ' <br /> FOR OFFIGE USE ONLY: <br /> FRONTSETBRCK REARSETBACK SIOESETBACN PLANCHECKy{1M�R/ FEE AECEIPTNO. <br /> / <br /> USE ZONE LOT AREA VACA4T SITE FEES VALUATION FEE <br /> � i <br /> ❑YE$ ❑ NO BUILOING �j J � <br /> HEIGHTLIMITATION NO.OFOWELIJ�G SIZEOFBLOG.RL L '1_ i <br /> UNITS PLUMBING � � <br /> OCCUPANCY NOA�STORIES OCCUPANTLOAD BASE�IENT MECHRNICAL /� � <br /> GROUP I N Q <br /> ❑YES O � <br /> � <br /> ADDITIONAL PLAN f.HECK � <br /> FIREAUAMPEO'D REASON � <br /> i <br /> OTHER � <br /> � <br /> FIRE SPRINKLER REO'D REASON / � <br /> STPTE BWL�ING SIIRCMARGE L ��-�� <br /> TYPEOFCONST. PLANSA�O'VF�DBV CITYOFEVERE7T PUBLICWORKS � <br /> I ' � LOCAL SALES � I :') <br /> ��I�+ DATE S Z�S SS TAX CODE IS 3105 TOTAL S'.� '��--, <br />