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,�.� _ _ _ _._ T,� _ <br /> �,"t �=� � <br />� ��Sp APPLICATION FAR CONSTRUCTION PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION Cl COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS �.�Z `�,\ �� W. C�4�� �`� c,} � <br /> � d,l�'b <br /> OWNER MAILADDRESS CITY 21P PHONE <br /> �(rY1C p , (.J�4 � <br /> TENANT MAILADDRE55 CITY 21P PHONE <br /> qRCHRECTOR�E516NER MAILAODRE55 LITY ZIP PMONE <br /> C <br /> �ENERRLCONTRACTOR MAILAOURESS CIN ZIP PHONE STATELICENSEf <br /> �s�.-�n� t�5 c�w C.Uu.N 7-_'�E 2- ���u 3 <br />� MECHANICALCONTRACTOR MAILADORE55 CITV ZIP PHONE STATELICENSEI <br /> PLUMBIN6CONTRACTOR MRILADDRESS CIN ZIP PHONE STATELICENSE� <br /> CONTR4CT PRICE OF WORK HEATING SYSTEM: AS ❑ ELECTRIC ❑ � <br /> DESCRIBE WORK AND SpUARE FOOT�OE INVOLVED C NT CT PERSON�ND P ONE NQO. � �, <br /> � r.� <br />' � a'�-"5� -3 s 6�`18 a3 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> P OPOSED USE OF BUILO�NS FR PROVISIONS OF LAWS AND ORDINANCES�OVERNINO THIS TYPE OF <br /> WORK WILL BE COMPLIED WIiH WHETHER SPECIFIED HEREIN OR <br />' LEGALDESCRIPTIO�IOFPROPERTYISHOWNBELO anrrncNtwocoaiEsl . NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO dIVE <br /> �aT_,�Q__e�ocK oF 4 AUTHORITY TO VIOLATE OR OANCEL THE PROV�SION OF ANY <br /> OTHER STATE OR LOCAL LAW nEOULATINO CONSTRUCTION OR THE <br /> D(V ,� PERFOPMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATtON IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOR5 LAW 1827 RCW AND 296200 WAC. <br /> PARC LD UMBER / �I j! <br /> CONSTR�CTIONLORNLENDER,A�DRESS.TELEPHONENUMBER X ��V�/1�`�l K/`�11�1�iL�I�I'1.�� _I ��' ( "' <br /> SIGNATURE .\��(� , { OATE <br /> ll � �.( <br />� CITY BUSINES$LICENSE NO. <br />, PLUMBINQ MECHANICAL <br /> Np, TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF flXTURE OR ITEM FEE <br /> WATER CLOSET(TO�LEn � A/C—A/HNDLQ UNITS—H.P. ' <br /> BATHTUB ; � FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � LAVATORY(WASH BASIN) � HEAT PUMP ' <br /> i <br /> - SHOWER � UNITHEATERS—@.T.U. M � <br /> ' KITCHEN SINK&DISP i CLOTHES DflYERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> � LAUNDRY TRAY ; RAN3E HOOD � <br /> CLOTHES WASHER � WATER HEATER ' <br /> ' URINAL ' WOOD STOVE � <br /> ORINKINO FOUNTAiN i METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNINO) ' <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR, ETC.) i 6AS RANpE ' <br /> � GAS PIPIN6 � <br /> � EXHAUST FAN ' <br /> i ' <br /> i i <br /> SUBTOTAL $ ; SUBTOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE S � TOTAL FEE S ' <br /> FOH OFFICE USE ONLY: <br /> FRONT SETBACN REAR SETBA� ,/� IDE SETBACK � PLAN CHECK NUMBER FEE RECEIPT NO. <br /> � —Z :.5� (v�`I 33 <br /> r . <br /> usE zor+ ` LOT FREA VACANT SITE FEES VALUATION FEE <br /> -/ l Z '3 ❑YES I:7 NO BUILDING 3 I <br /> J <br /> HEIGHTUMITAT9N� NO.OF�WELIJNG SIZEOFBLD R �a <br /> �� UNITS zS���G�p�4 } PLUMBINO (/� <br /> OCCUPPNCY NOAFSTORIES OCCUPPNT�OAD 9�SEMENT MECMANICRL (J O�7 <br /> GROUP ^ <br /> � J L ❑YES NO <br /> ADDITIONAL PLAN CHECN <br /> FIREAUPMREO'D RCASON <br /> OTHER <br /> FIRE SPRINKLER REO'D REA50�I <br /> STATE BUILDING SUFCHARGF �- �� U <br /> TYPEOFCONST PLANSAPGROVEOBY CITYOFEVERETT PUBUCYlORKS 7L��\t/O <br /> }7''' `J� LOCAL SALES ' � � � �c:� <br /> y�—I�I OATE �^76 _ TAX CODE IS 3105 TOTAL <br />— <br />