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{ �f /I�3 <br />, , <br /> -��sD ` , <br /> APPLICATION FOR CONSTRt1CT10N IyERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITIOtd ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ F�LUMBING O SION <br /> PROJECT ADDRESS <br /> S�t.� � ` a C�.� LJ. <br /> JWNEfl MA�LRUDRESS CITY ZIP PMt,.^.° <br /> t�� l4U�o Px��. (� �.�:� am� ,9�cc w�r . (�y5��� <br /> TENANT .'AnILADORESS CIiY ZIP PXONE <br /> ARCHI7ECTOROESIGNER MAILAUDRESS CITY ZIP PHONE <br /> SoanL �: ��v�w <br /> GENEPALCONTRACTOR MRILA�C^555 QTV ZiP PHONE �T�TELICENSE� <br /> t�u-mc �� rlw,nw Cvu.n�T= � a �o,�,�J <br /> MECHANICALCONTiiACTOR MAILA�CFE55 CITV 21P PHONE STATEUCENSEII . <br /> PLUMBIYG CbNTRnCTOR MAILAODRE55 CIN ZIP PHONE STATE LICENSE� <br /> CONTPACT PRICE OF\VORK ' <br /> HEATING SYSTEM: QAS ❑ELECTRIC ❑_ <br /> DESCRIBE WORKAND SOUARE FOOTAOE INVOLVED C NT CT PERSONANO P ONE NQO. � �7 �/� <br /> l� y. <br /> 5�� fi s 6�f9�8 a3 <br /> • I HEREBY CERTIFY THAT I HAVE READ ANP EXAMINED THIS <br /> � � APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> P OPOSED USE OF BUILOING PROVISIONS OF LAWS AND ORDINANCES C,OVERNINO THIS�7YPE OF <br /> S WORK WILL BE COMPLIED Wlhl WHETHER SPECIFIED HEREIN�OR <br /> LEOALDESCRIPTIONOFVROPERTY(SHOWNBELOW ATTACXTWOCOP.IES) NOT. THE 6RANTINCi OF A PERMIT DOES NOT PRE3UME TO OIVE <br /> �oT�eiocK oF �Gl� UTHORITY TO VIOLATE OR CANCEL THE PR6�VIS�ON OF ANY <br /> OTHER STATE OR LOCAL LAW REQUUITINO CONS7F�UCTiON OR THE <br /> P��/ Z PERFORMANCE OF CONSTRUCTIGN.THAT I AM AUThORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WCFiK FOR WHICH <br /> ��� � UO O�' � a JJ (7 APPLICATION IS MADE AND I COMPLY WIT.I' THE STATE <br /> PARCELTA%I.D.NUMOER CONTRACTORS LAW 1827 RCW AND 298.200 WAC, . <br /> � CONSTRUCiIONLOANLENDER,ADDRE55.7ELEPHONENUMBER x n� W�Q�I'IIW�t� � <br /> , �' — SIQNATl1RE �ay� y� OATE <br /> ,. <br /> � CITY BUSINE55 UCEN5E NO. <br /> � PLUMBINO MECHANICAL <br /> � NO. TYPE OF FlXTURE OR ITEM FEE N0. TYPE OF FU(TURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—AIFiNDLG UNITS—H.P. ! _ <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. j _ <br /> T <br /> , ' LAVATORY(WASH BASIN) S � HEAT PUMP ' <br /> / SHOWER _ � ' UNITHEATERS—B.T.U. M , � <br /> � / CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP i � <br /> / DISHWASHER � VENTILATION FAN T— <br /> LAUNDRY TRAY ; / RANQE HOOD __� <br /> CLOTHES WASHER � WATER HEATER _ ' <br /> URINAL ' WOOD STOVE � <br /> DRINKINO FOUNTAIN � METAL FIREPLACE(WOOD BURNINO) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNINO) ' <br /> BACKFLOW PREVENTERS i 6AS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANOE ' _ <br /> � QAS PIPIN� � _ <br /> ; � EXHAUSTFAN ' <br /> � � <br /> i <br /> � i <br /> � � SUB TOTAL S � ' <br /> SUB TOTAL $ �; <br /> PERMIT $ � PEfiMIT S � <br /> TOTALFEE $ � 70TALPEE 5 ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETSaCK REAR SETBACK SIDE SFTfiACK PIAN CHECN NUMB R FEE RECEIPT NO. <br /> zS � h ' �•7S � 7S � �_� . � — <br /> us[zor+� ` LOT AREAL-�p� VACR-NT�/SITE FEES � VALUATION FEE � <br /> ��' -J �Z �'2J IA�ts n NO BUILDING -18 3V / �'[J <br /> HEIC>MTLIMIzT�ON UNITSFD%ELLING 512EOFBLDG/j�I J/ .T <br /> '�(p �FS�F� LIV/`�i} pLUMBING /[J <br /> Q'CUPANCV NO.OFSTOPIES OCCUPANTLOAD (BASEMENT MECHANICAL <br /> GRIUP / <br /> �;� �'/ Z � � OYES CB'NO <br /> FIRIEAURMREO'D REASON ADDITIONALPUNCHECK '�- <br /> OTHER <br /> FIRE SPRINKLEF REO'D NEASON <br /> STATE BUILDINO SURCNAROE � <br /> TYPEOFCONST PLANSPPPROVEDBY ����YOFEVERETT PUBLICWORKS � � � - <br /> -T7- J�} �LOCALSALES , � <br /> ,1L /J DATE 2 �2'L $6 TAX CODE IS 3105 TO7AL <br />