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APPLICATION FOR CONSTRUCTION PERMIT <br /> F 9 3 2� 13 '�:ITY OF EVERETT• HUILDING DIVISIO <br /> 3200 �EDAR STREET• EVERETT, WA 982Q1 •259-8810 <br /> O DEMOLITIOM O COMBINATION BUII.DING ❑ lAECHANICAL ❑ PLUMHING ❑ SIGN <br /> PROJEi.T ADDRESS �j� ���' <br /> � <br /> — '� ,�S `jj,✓r 6�/ <br /> �O NER M,A`�ppDRESS PMONE <br /> c�ood �L�t�rua ly<-//o �c12ad �d # aoo� /��.Ll�azu LUR �iyy �z� <br /> TENANT <br /> CITY Zlp PHONE <br /> ��HRECTOHDESIGNER MAILADDRE55 CITV ZIP PHONE — <br /> •�a�u a�, U .�m�n <br /> GENEHAI.CONTRqCTOR MNLpDORES: CITV 21P PHONE � STATELICENSE� <br /> �airnt l,Ita n�.rr�� Co N r.r*� 1 o MJ <br /> MECHANICALCONiRACTOR MAILAODRESS CITV IIP PHONE STATEIJCENSE� <br /> PLUMBINOCONTRACTOR MALA�DRE55 CITV 21P PHO�� STATELICENSE� <br /> CONTIUCT PRICE OF WOpK <br /> � �P ! °I � HEATING SYSTEM: GAS ❑ELECTRIC ❑_ <br /> DE E WORKA SOUARE F TACE INVOL D � O AC7 PERS AN PHONE NO. � <br /> .�Jm, �o�in y9- 8/SS <br /> 3 S 8 2 f 8 o v a�'a 7-A�Et �t a�a (i�,/ - I 7 <br /> p r.Q.�C # a Ff L( I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> �j � � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEOaLDESCHlP71 OFPROPEH7Y�SHOWNBELOWOpA7TACMTWOCOPIES) WORK WILL BE COMPLIED WI7H WHETHER SPECIFIED HEREIN OR <br /> �or� e�ocK NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME TO GIVE , <br /> oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> � / , JOTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> � �/1/� I � I�I��L!S Tr PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PHOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> rance�T,�z i.o.NUMeea — CONTRACTORS LAW 7827 RCW AND 296200 WAC. <br /> R1 �5- bo0 - C>S �/ . //•� � � <br /> CONSTRUCTON LOAN LENDER,ADDRESS,TELEPHONE NUMBEq ��I�. � / �/y/�_„ <br /> x ..,.. .—,.� �-a 3 -�aS <br /> SIdN�TUflE � �y a 4� OATE <br /> CITY OU&NESS LICENSE'.: <br /> PLUMBINO �MECHANICAL <br /> NO. TYPE OF flXTUpE OR ITEM FEE N0. TVPE OF FlX7URE OR ITEM FEE �— <br /> WATER CLOSET(TOILEn � A/C—A/HNDLO U�;ITS—H.P. , <br /> BATHTUB � FORCED AIR SYSTEMS—R.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP <br /> SHOWER ' <br /> ' UN�T HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP � � - <br /> I � � CLOTHES DRYERS � <br /> _J_ DISHWASHER � VENTILATION FqN , <br /> LAUN�RYTRAY ; qANQEHOOD � <br /> CLOTHES WASHER � WqTER HEATER <br /> URINqL --;� ' _ <br /> WOODSTOVE � � � <br /> _ DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNINc;) � ' �.�� <br /> _ FLOOFt DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> , SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> � <br /> ' GAS PIPING � <br /> � EXHAUST FAN , <br /> i — <br /> i _ <br /> � <br /> i � <br /> � �- <br /> SUB TOTAL $ � SUB TOTAL $ � <br /> PERMIT ' <br /> $ ' PERMIT $ � <br /> TOTAL FEE a � T07AL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FROHf SETBACK � qEAR SE7gqq�� SIDE 5 ti��/ PUN CHEC//U�E� � FEE �� RECE�%%/ - �J <br /> %V %� y� <br /> usez/� � LOTAREA VAC�NTSITE FEES YALUATION FEE <br /> ❑VES ❑ NO BUILDING 2FjO Z �/ <br /> HEIGHTLIMITATION/ UIlIiSFDWEWNO SIZEOFBLO(VT.. /LO� � <br /> . 3(�Z ���G� PLUMBINO ID�J� <br /> OCCUPANCV Np.OFSTOWES OCCUPANTLpqD BASEMEM <br /> GROUP 3 Z ^ � / MECNwNICAL <br /> � /+ OVES �F10 <br /> FIqEAURMREO'D REASON AJDITIONALPLANCHECK �i-- <br /> }i— <br /> FIRESPRIN�ppEO'0 pEASON OTHEA �/vJ/�� I JG� <br /> �✓iv � / <br /> �IV STATEBUILLINGSUFCHARGE / � . <br /> L <br /> TYPEOFCONST. PLqNSAPPROVEDBV CITYOFEVEREIT PUBLICWOPKS <br /> J�"! LOCAL SALES 2D� <br /> -nl o�re � 26/9S TAX CODE IS 3105 TOTqL � <br />