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� ��. /,^ ��� <br /> 1 <br /> G �'1 /1 <br /> l�� <br /> APPLICATION FOR CONSTRUCTION PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CELAR STREET• EVERETT, WA�J8201 •259-88'10 <br /> O DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SfGN <br /> PROJECT ADDRE'SS �_/ / �� <br /> �J—! �8 � � S�' C(..trz LJ `CAl�"u�', WY�— � S� �U j <br /> OWNER ,/y�M�AILADDRESS /�C�ITV ZIP p� �� �PMONE G <br /> ie11J�,/T�bV (a�����.f ���0 �,�c(.(i.oti. 1'�- Stu.t[ a bU fJu.0 , W�4 �y/' �� � <br /> TENANT MAIIADDRE55 CITY 21P PHONE <br /> AHCHITF:CT OR DESIGNER MAILADDRE55 CITY 21P PMONE <br /> Jd�lCIL�_�i..`i 79,�]Y1�V <br /> GENERALCONTIiACTOR MRILAOORE55 CITV ZIP PHONE STATELICENSE� <br /> tr�-m� ��-s c�►�rnw C.Ot.t,NT Z'�E a 1 oM.T <br /> NECHANICALCONTRACTOR MRIIADDRE55 CITY ZIP PHONE STATEUCENSE� . <br /> ' �' <br /> }��f f <br /> � i�� � <br /> PLUMBINOCONTRACTOR MaILA0DRE55 CIiV ZIP PHONE STATELICENSE� � '�+� <br /> CONTRACT GRICE OF WORK . :;r`r�i <br /> HEATING SYSTEM: ❑GAS LECTRIC ❑ <br /> DESCRIBEWORKANDSOUAREFOOTAGEINVOLVED G MCTPERSONAN7P ONENQO. � '�/ � �^`�;�i� <br /> Sn: <br /> � 65 s �Yy, g�a3 ;;' :��. <br /> � � I HEREBY CERTIFY THAT I HAVE AEAD AND EXAMINED THIS - �� �`�„`,; <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> P OPOSEDUSEOFBUILDINSr R � '.��'J��t� <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDE OFPROPERTY;sHawrieuow RRTTACHTWOCOPIES NOT. THE ORANTINQ OF A PERMIT DOES NOT PRESUME TO OIVE . � . � <br /> wT e�ocK oF l�• �h AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> �v OTHER STATE OR LOCAL LAW REQULATINO CONSTRUCTION OR THE . <br /> ' PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE � <br /> • �i OWNER OF THIS PROPERTY TO PERFORM�7HE WORK FOR NhiICH � <br /> 8 I 3S " l7U O -� Gf, �JUUO APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTA%I.D.NUMBEP CONTRACTORS LAW 1827 RCW AND 296200 WAC. . <br /> CONSTRUCiION LOAN LENDER,ADDRE55.TELEPHONE NUMBER X �� L[��Jj�C .L �l�� �� � , <br /> SIONRTURE ,\�'t� � DATE � <br /> lJ J <br /> CITV BUSINESS LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flIRURE OR ITEM FEE NO. TYPE OF flXTURE Oii ITEM FEE <br /> WATER C'_OSET(TO�LEn � A/C—AMNDLO UNITS—H.P. � <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK&DISP i CLOTHEfi ORYERS ' i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANOE HOOD ; <br /> CLOTHES WASHER i WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> CRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNINO) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNINO) � <br /> BACKFLOW PREVENTERS ; GAS PIREPLACE � <br /> SINK(SERVICE—BAH, ETC.) � GAS RANdE � <br /> ' GAS PIPIN6 ' <br /> � EXHAUST FAN i <br /> i � <br /> � i <br /> SUB TOTAL $ ; SUB TOTAL S _�_ <br /> F'ERMIT $ i PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE $ ' _ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACH J REAR SET A � IDE SETBRCK' /�' PUN,H�NUMBER FEE AECEIPT NO. <br /> / �j <br /> \/ G <br /> usezoNe r� �ornnen CACRNTSITE FEES VALUATION FEE <br /> Z ❑VES ❑ NO BWLDING Z� � <br /> HEIGHTLIMITA_TION J NO.OFOWELLING SIZEOFl�LDG?I ��� <br /> L=�v. UNITS Z Y}/9' $�� L lv/IJC�"�' PLUMBINO <br /> ) ARAvS <br /> OCCUPANCV NO.OFSI0PIE5 OCCUPANTLOAD BASEIAEN7 MECHRNICAL Q �D <br /> GROU <br /> - V' � 2 ❑YES O <br /> FIR ALAPMREO'D REPSON ADDITIONALPLANCHECK <br /> OTNER <br /> FIRE SPRINKLER PEO'D REASON <br /> STATE BUILOINO SURCHAFGE <'"� <br /> TYPE OF CORS? PLANS APPR VED BY CITY OF EVERETT PUBLIC WORKS � �7 <br /> I� LOCAL SALES <br /> oare <br /> 1'. � (�, TAX CODE IS 3105 TOTAL �.� �� <br />