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$3�17 APPLICATIOW FOR CONSTRUCT.JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, VVA 98201 •259•8810 <br /> ❑ DEMOLITION C7 COMBINATION I BUILDING CI MECHANICAL CI PLUMBING I� SIGN <br /> PROJECT ADDRESS �, I'D ,� <br /> 'r ''�✓ �}Vi I.Jd 5'�' <br /> OW ER MFILAOORE55 CITY ZIP PHbNE ' <br /> T�NT �''"uwnad M�oon�.sT�a. ly�lrot�,,(A'.rd I?d � �cn � 9Soa? WS�-33s3 <br /> A HITECSONDESIGNER M41LA��RE55 GITV ZIP PHONE � <br /> �a�rru AS Q..s� <br /> GEjJEFALCONTRACT R M�SS CITY ZIP PHON[ � O� �5���� JI orvl7 . <br /> J <br /> MECHAMCALCONTRACTOR MAILADDFE55 CIN ZIP PHONE STATELICENSEY <br /> PLUMBING CONT.7ACTOR MAILAODRE55 CIN ZIP PHONE STATE LICENSE 1 <br /> CONTRPC�PRICE OF WORK <br /> J �j�� -rj00, Od HEATINGSYSTEM: L AS ❑ ELECTRIC ❑ <br /> DESCRWGWCR(ANDSO EFOOcTA�I�OLVED, � LONjACjPEIR90NAND�}10NEN /�� ���^ �/S� <br /> _—� J I YI �y! /L�IIr ({ � <br /> Z 5� 8 I�jy�ai,- G � nc �y9- 8178 <br /> �y�G � a38 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS � <br /> APPLICATION AND KNOW THE SHME TO 8E TRUE AND CORRFCT.ALL <br /> Ff10POSED U,-:E OF BU'IDING p PROVISIONS OF LAWS AND ORDINANCES GOVEflNING THIS TYPE OF <br /> S F 1� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR � <br /> ' "iRLDESLCR'I�FTIONOFF'ROPERTY�SHO\4NBELOWORATTACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO G�VE <br /> . ioT,�[__e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> W I A I II � FERFORMANCE OF CONSTRUCTION.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 /> PARCELTAX I.D.NUM ER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRl1CTI0NLOPNLENDER.ADDRE�.7OE�HONENlIMBER X �r}}.� (// C�� �� Q I /S <br /> SIGNATl1RE � n � 2�� DATE �� <br /> i <br /> CITY BUSIHESS UCENSE N0. <br /> PLUMBIN6 FAECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE O��lXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A!C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; fORCED AIR SYSTEMS—B.T.Ii. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNITHEATE{iS—B.T.U. M ' � <br /> � KITCHEN SINK&DISP CLOTHES DHYERS � � <br /> DISHWASHER � VENTILATION FAN � <br /> LP.UNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATEF � <br /> URINAL ' WOOD STOVE ' <br /> _ DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKF:OW PREVENTERS � GAS FIREPJICE � <br /> SINK(SERVICE—BAR, EiC.) � GAS fiANGE � <br /> ; GAS PIPING ' <br /> � EXHAUST FAN � <br /> � i <br /> i � <br /> _ � � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL $ ; <br /> PERMIT $ � PERMIT $ i <br /> _—�— <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FROMSETBAC�/ REARSETBACN � SIDESETB,CK� / PLANCHECN�NUI�ER� FEE FECEIPT%�� )/7 <br /> 7i i�i C� ' Li 7 0, <br /> r <br /> ilSE 20NF LOTAR A VACANT SITE � FEES VALUATION FEE <br /> f7YE5 Il NO � � � <br /> _ P7ILDING �J b �C-�'� <br /> HEIGHTUMITATION � NO.OFOWELLING SIZEQE.�Df/f.l �� V � � <br /> UNITS Z OSv SF L� r•! .� v�u�aoiNu /r�.5 i U� <br /> Z tf A�.`' <br /> OCCUPANCY NOAFSIOFIES OCCUppNTLOAO BASEMENi '� �. � <br /> GR P MECHANICAL � �, � ,,. 1 <br /> -3 Z itl ��ES � , <br /> AD�ITIONFL PLAN CHECK i <br /> FIREAURMREO'D REASON i <br /> /��� OTHER �' � ' �.�. �/� iO0 <br /> FIpE SPRINKLEfl REO'� REASON ' � <br /> STATEOWL�MLSURCHARGE � i�.,) <br /> TYPE OFCONST PLANS APPROVED BY CITY OF EVERETT PUdI.IC WORRS �1 J j�i:7 <br /> � � �f'a , LOCAL SALES � <br /> onTe ,� � S TAX CQDE IS 3105 TO7AL 1 �/!� (� ;nc� <br /> -"_^'"�"'�'"` <br />