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g:z r� <br /> 'L .-, .-, <br /> S�� APPLI�ATI1��1 FOR CONSTRlJC1 �ON PERMIT <br /> CITY UF EVERETT• BUILDING DIVI:,ION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> ❑ DEMOLITION ❑ COMBINATIOM �BUILDING ❑ MECHANICAL ❑ PLUM8ING ❑ SIGN <br /> PROJECTADDRESS ��/� ���v� ` , <br /> (.lJ <br /> ONNER MAILA�ORESS CTY ZIP PHONE <br /> �o�1�f �'��s ���tm PX,c.F'.�. �i_ c�,a:t.� a m> B�cc � � �y5• �i �i <br /> TENANT MAILAODRE$$ CITY ZIP PHONE � <br /> ARCHITECTOROESIGNEH MAILAD�PESS CITV ZIP PHONE <br /> GE ERALCONTRICT R �'Mp��qE55 CIIY ZIP PHONE STATELICENSEI <br /> kk-InG C� L�k,`Y1W C[�l-t.JU T'._�E a 1 O M 3 <br /> MECHANICALCONiRSCTOR MAIIADORESS CITY ZIP PHONE STATEI CENSE� <br /> PIUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE I <br /> _L�1�1L2 <br /> CONT ACTPRIC O WOFK <br /> HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> ESCRIBE WORKAND SOUARE FOOTAGE INVOLVED C NT CT PERSON ANO Pr10NE NO. <br /> nLL� f �YL�Yan.���r� M QL� �v�f SI > <br /> � a � a, vh s (���� 8 a3 <br /> �� .� I HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> rrioaoseo use oF euaoiNO — APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> S F PROVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS TYPE OF <br /> WORK WILL BE COMP!IED WITH WHETHER SPECIFIED HEREIN OR <br /> L'cGAlDESCRIPTIONOFPROPEflTY�SHOWN9ElOW ATiAC��TWOLOP.IES� NOT. THE GRANTIN6 OF A PERMIT DOES NC'i PRESUME TO GIVE <br /> � �or�BLOCK _OF Q�'�" w��' �` �� L9�UTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAI L4W REGULATING COIJSTRUCTION OR THE <br /> ' PERFORMANCE OF CONSTRUCTION.THAT I AN AUTHORIZED BY THE <br /> (� OWNER OF THIS PROPeRTY TO PERFORM T4E WORK FOR WHICH <br /> � 7S U L� • (�C�O � U�-� APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> anace�T,ix i.o.r+un+eea ' CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRUCTION IOAN LENDSR,ADDRESS,TELEPMONE Nl1MBER X ���/yl ����� �/�O /y � <br /> SI�NATUFE ���� � OATE <br /> � CITY BUSINESS LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF FIXTURE OR ITEM FEE � <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; / FORCED AIR SYSTEMS—B T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP i <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITGHEN SINK$DISP � CLOTHES DRYERS � <br /> � DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY � RANGE HOOD � <br /> CLOTHES WASHER i WATER HEATER i <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � I FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; 1 GASFIREPLACE ; <br /> SINK(SERVICE—BAR, ETC.) � OAS RANOE � <br /> ' GAS PIPING ' <br /> � EXHAUSTPAN � <br /> i � <br /> i i <br /> i i <br /> � � <br /> SUB TOTP.L S ; SUB TOTAL $ ' <br /> i <br /> PERMIT $ � PERMIT S � <br /> TOTALFEE $ � TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: � �� <br /> FRpNT SETBACR PEAR SETBACK SIDE SETBA�CK7 � PLAN CHECK NUMBER FEE RECEIPT NO. <br /> ZS� �5 � /• s � D <br /> uSEzor+e �� LOTRREA VA:ANTSITE FEES VALUATION FEE <br /> - � � . VES CI NO B111�DING t'31 <br /> HEIGHT LIlAITATION N0.OF DWELIING SIZE OF BLDO .I. � <br /> Z R � UNITS / 'L�{(VI �F. LIV/N�1 p�UMBINO � <br /> �� S.F. RAc>� <br /> GROUPANCV NO.OFSTOPIES OCCUPANTLOAD BASEMENT MECHANICAL � <br /> R-3 Ua oves � � <br /> F dE LARM REO'D REASON A�DITIONAL PLAN CfiECK � <br /> OTHEP � <br /> FIRESPRINKLERFEO'D REASON � <br /> STATE BUIl01N�SURCHARGE � I <br /> TYPEOFCONST. PlANSAPPR V�DBV CITYOFEVERETT PUBLICWORKS D � <br /> �F1 LOCALSALES <br /> "l� onre 3J�`f� TAX CODE IS 3105 TOTAL � <br />