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APPLICATIf,�I FOR CONSTRUCT�O�i PERINiT <br /> � q � �-� .;ITY OF EVERETT• BUILDING DIVISIOt� <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAI O PLUMBING ❑ SIGN <br /> PROJECT ADDRESS s � �4 �5,�-L �� i 1��. <br /> �1J <br /> Oy�ER MRIIAUDRE55 CITY ZIP PHONE <br /> (.O�u ��raood !-Fs»uo l�/ylo � 12rd !�d # aa: , /�,Gl�u•r� I.tJR �yy-�� <br /> TENANT MO�LADDRESS CITv ZIP � PHONI. <br /> A NITECTORUESIGNER M�IIADDRESS CITY :IP rnJt:c <br /> �� Rn [�UJn.!/1 <br /> GENERALCONTRACTOR MAIL�DDRESS CIN ZIP PHONE STATELICENSE� <br /> :e�amu aa (��.n,�, CouNrr�� ioM� <br /> MECHIWICALCONTR�CTOR MAILAODPESS CITY 21P PHONE STATEUCENSEr <br /> PLUMBINQCONTRRCTOR MAILAOJRESS CIN ZIP FMONE STATELICENSEY <br /> CONTMCT PRICE OF WORR I � � ^ �` _ <br /> N (� HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> DE���RK A1 SOU�RE FOp?A� �OLYE� , ON r1C7 PEFS AN PHONE N0. 9� �/ ^� <br /> f <br /> � l/VLV !"' ' <br /> 3 5 8 a f 8 0 o ar�a Ta t� a'�c+na [i�?�_ <br /> f,2 ��C #, �0% I HEREBV CERTIFY THAT I HAVE REP. AND EXAMINED THIS <br /> v D rr APPLICATION ANU KNOW THE SAME TO b' �FUE AND CORRECT.ALL <br /> PROPOSEDUSEOFBUILDINO n PROVISIONS OF LAWS AND ORDINANCES GOVERNI4G THIS TYPE OF <br /> S F /` WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> lEfi�LDESCRIPT70NOFPROPEqTY(SXOWNBELOWORATfACHTNOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or� BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY � <br /> ,r� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � " ��'�m� � ��^�5 � WNER OFNTHIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCELTA%I.D.NUMBEP CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> 813 S- Ooo - b 5 x /��i�►�- G`�i � l�j"% <br /> CONSTRUCTONLOANIENDER.ADDRE55.lElEPMONENUMBER <br /> SIGNATUflE A �� ^�'I OATE <br /> �� O �/ <br /> QTV BUSINESS IICEN-.e NO. <br /> PLUMBINO �MECHAN�CAL . <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF Fl%TURE OR ITEM FEE <br /> WATERCLOSE'f (TOILET) � A/C—A/HNDLOUNITS—H.P. ! <br /> BATHTUB ; PORCED AIR SYSTEMS —B.T.U. M E.A. _�_ <br /> . LAVATORY(WASH BASIN) � HEAT PUMP ' <br /> J SHOWER � UNITHEATERS—B.T.U. M :_ . <br /> 1 ' � CLOTHES DRYERS � <br /> KITCHEN SINK 6 DISP � <br /> J DISHWASHER � VENTILATION FAN ' <br /> LAUNDRYTRAY ; kANGEH00D � <br /> CLOTHES WASHER � WATER 4EATER ' <br />� URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BP.R,ETC.) � GAS RANGE ' <br /> � GAS PIPING � <br /> , EXHAUSTFAN � _ <br /> � - <br /> i � <br /> i � T <br /> I L�� <br /> i SUB TOTAL $ ; SUB TOTAL S ; <br /> � PERMIT $ � PERMIT $ � <br /> TOTAL FEE $ � TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRO��� ) REAR� ACK SIDE SETBACK �` � PLAN CH�K�MBER FEE� RE�IPT NO. .� <br /> � / � �' G' ///=r <br /> � �/: <br /> USEZONE �. LOTAREA �ACANTSITE FEES VALUATION FEE <br /> �+� ❑VES ❑ NO BUILDINO 1�1 2 �I <br /> 2�0 5. ..J <br /> HEIOntUMI�C�ON /� NO.OFDWEWNG 512EOFBLDGRI, - <br /> Jp � UNITS �ja"SZ SF ruv���v pWM81NG D�7 <br /> liC7 300 S' n ac= <br />� OCQIPANC� NO.OFSTONES OCCUPAMLOAO B�SEMENT � <br /> GROUP � MECMANICAL /�G i <br /> 3 2 ❑YES ANO � <br /> FIFEAURIAREO'D REASON ADDITIONRLPLANCHEC3 �_ <br /> i <br /> _ OTHER ��J�� / /� i <br /> FIRE SPRINKIER RE�'D REASUN � � <br /> J STFTE BUILDIkG SURCNARGE L � <br /> TYPEGFCONST. PLANSMFROVEUBY CITYOFEVERETT PUBLICWORKS �[/i <br /> �.J y LOCAL SALES ; <br /> - DATE ► 5 TAX CODE IS 3105 TOTAL � I <br />