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�cp ��, �►PPLICATI��1 FOR CONSTRU�'�.�ON PERMIT <br /> C�m 6!�r „ITY OF EVERETT• QU�LDING DIVISIOh <br /> (��'Z�'qy) 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION BUI!DING ❑ MECHANICAL ❑ PLUMBIKG ❑ SIGN <br /> �ROJECT ADDRESS S �i 3 D �2 S�= Q(rC ��(rp7(� <br /> U ER MALADDRE55 CITV ZIP PMONE <br /> �,v�.tiu,c�ood I-�er�ue 1�/y/o � I��.�d !�d # aoo, /�Gltazu LUR �iyy-�,� <br /> TENANT MAILADORESS dTV ZIP PNONE - - <br /> A Hlf� TECTOROESIGNER `` M�ILADORE55 CITY ZIP PHONE <br /> )/1N�1�.� 1AC/ V�� . <br /> GENERALCONTRACTOR MAILADORE55 CITY ZIP PHONE STATELICENSEY <br /> .�a,n,� c�o (�,,,y,�, C o u ni rr�a !o M 7 <br /> MECXAkICALCONTRACTOR MAILADDRESS C17V ZIP PNONE STATELICENSE� <br /> I PLUMBINO CONTRACTOR MAILADDPE55 CITV ZIP PHONE STATE LICENSE• <br /> CONTRAC'YH:CE OF WORK <br /> I J 3 S aj� Ic�3 � HEATING SYSTEM: GAS ❑ ELECTRIC ❑_ <br /> DE BEiVORKA $OUAREF TAGEINVOL ED , ON AC77EFl5 AN PMONENO. - �/�� <br /> � 3 [. 5 �- ! S �i4 Ta�t �t ana Liy - I 7 <br /> gq,Q�� #. 303 • -�,,,� �J(ans I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THG SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSEO USE OF BUILGu.� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> S F /Z WORK WILL BE COMPLIED WITH WHETHER SPECIFIE� �iEREIN OR <br /> LEGALDESCRIPTi7NOFPROPERTY�SHOWNBELOWOfiATTACHIWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUPr1E TO GIVE <br /> �or� e�ocK oF_ AUTHORITY TO VIOLATE OR CAP�CEL THE PROVISION OF ANY ' <br /> J ,_ ' / � � OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> PDW�{A/'/YY�(M I,I an ds �L PEP.FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AMD 1 COMPLY WITH THE STATE <br /> PMCELT:�X I.D.NUMBER CONTRACTORS LAW 18'7 RCW AND 296200 WAC. <br /> 135- Ob� � Do X �l�r- �j � 1��3��15 <br /> CONSTAUCTION LOAN LENDER.AODflESS,TELEPHONE NUMBER <br /> SIGNPTURE ���a y� DRTE <br /> CIT'BUSINESS LICENSE N0. <br /> � PLUMBIN6 �MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> �, WATER CLOSET(TOILE"f) � A/C—AIHNDLG UNITS—H.P. � <br />� � BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.ti. ; <br />' � � � LAVATORY(WASH BASIN) � HEAT PUMP � <br /> � � SHOWER ' UNIT HEATERS—B.T.U. M � � <br /> KITCHEN SINK&DISP i CLOTHES DRYERS i <br /> DISHWASHER � � VENTILATION FAN � <br /> LAUNDRYTRAY ; RANGEHOOD ; <br /> f CLOTHES WASHER � WATER HEATER � <br />� URINAL ' WOOD STOVE ' <br /> ORINKINO FOUNTAIN � METAL FIREPLACE(WOOD BURNING) 0 [ihCt, <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GA.S FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GNS RANGE � <br /> ' GAS PIPING ' <br /> i EXHAUST FAN i <br /> — i i <br /> - � � <br /> i � <br /> � ' <br />' SUB TOTAL $ � SUB TOTAL $ � <br /> � PERM�T $ � PERMff $ � <br /> �OTAL FEE $ ' TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FROM SETBACK REAfl SETBACK SIDE SETBACK PIAN CHECK NUMBER FEE RECEIPT NO. <br /> z5' i���M r�� 7.s� lv� �- �/7a� i�.a7 <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> -S � 'j,7�o ,dves ❑ No auaowc Z �� <br /> � <br /> MEIOHTUMITATION NO.OFOWELIJNO SIZEOFBLOGR.I. i <br /> � UNITS � Z?���SF��GE + pLUMBING i <br />� JCCUPANCY NO.OfSTOPIES OCCUPANTLOAD BRSEMENT O � <br /> GROUP MECHRNICAL � <br /> .3 N � oYEs � � <br /> ADDITIONRL PLAN f,HECK j <br /> FIREAURMREO'D REASON i <br /> O OTHER '— <br /> f�l�J/I � <br /> FIPE SPRINNLER REO'D REASON � <br /> U STATE BUILDING SURCHAPGE i ) <br /> TYPEOFCONSL PUNSAPPROVEOBY CITYOFEVERE7T PUBLICWORKS � � � <br /> � LOCALSALES � <br /> �—� DATE 2/7I9S TAX CODE IS 3105 TOTAL - Zi' I - � <br />