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--. .�. <br /> APPLICATI4N FOR CONSTRUCI rON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION Cl BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br /> PROJECT ADDRESS �5�_�S�-' Sr [V�YG�-�'t w�" 9��d� <br /> OWNER T � ��'IG�U��1R CIIY ZIP PHONE <br /> �ao Noll r�d �. c�A�l�s �A �'ix���g' ai3 -�d-9s3� - <br /> TENANT �AD R�� CI r ZIP FHONE <br /> �� 7 <br /> L 9(7'u ) � — <br /> pRCMITEGT OR�ESIGNER MRILAO�RE�S Lltt ZIP PHONE �b�a 3ta� <br /> =���1 aci�n Cm� l�t��o-yy�' {�_.�nl� H Lyhh,..�,Sc1�4Sb3� ,,� <br /> GENERRLCONTPACT H MpILAD�RE55 CITY 21P PHCNE STATELICENSE� <br /> LC�lcw�v�-�s � 31 a�-�ISth f�L r�l Mal��ll�eo ,Wf� `i���r, ct�r��14�IS <br /> MECHANICALCONTRACTOF MAIIADORE55 Cltt ZIP PHONE STATELICENSE♦ <br /> PLUMBINGCONTR�CTOR MAILA�OPE55 CITY 21: PNONE STFTEUCENSE� <br /> CONTR�CT PFICE OF WOPK <br /> �SS�I' J� HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> DESCRIBE WORK ANO SOURRE FOOTFGE INVOWED - CONTACT PEPSON AND PHONE NO. � t�J � '�J �,D/ <br /> .� � x I o� X 3 �{" o PL 6�6,U v L� YJ <br /> •ro �s� Honl6 or� .BUIc-DiNL� l�.i/+� CF�u�-I <br /> r,, � s''�� I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> 1DU�+TI FIC � I 1J AppLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � aaoraseo use oF euaoir+c ' pROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TVPE OF • <br />. . � r�-me.nl5 M��'�m� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCFIPTIUNOFPPOPERTYISHOWNBELOWOFARACMTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT�y'�31'� e�ocK��� p"�oF fh 51� AUTHORITY TO VIOLATE OR CANCEL THE PROVIS�ON OF ANY <br /> I1- ` � ' OTHER STATE OR LOCAL LAW R[uULATING CONSTRUCTION OR THE <br /> 'j� n ��}�� EV� Tr Sr�r�'16��'I PEAFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> / A� 1� ,Q' ��[� OWNER OF THIS PROPERTY TO PERFURM THE WORK FOR WHICH <br /> (yl,r)'I� Y��IT l�5 �lr �fr (�CCO�'CCL� It1✓ lr$. Uf APPLICATION IS� MADE AND I COMPLY WITH THE STATE <br /> PARCELTAX I.D.NUMBER � �q CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> ✓ �,,y� <br /> CONSTqUCTION LOAN LENUER.AO�RE55,iEIEPHONE NUMBER X �7/L Q.A Il�+�/�Y�"- <br /> 5 NA RE DATE <br /> CITY BUSINE55 LICENSE NO. <br /> - PLUMBING MECHANICAL . <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF FIXTURE OR ITEM FEE <br /> � WATERCLOSET(TOILEn � A/C—MiNDLGUNITS—H.P. ' <br /> BATHTUB ; FOPCEDAIRSYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP ' <br /> SHOWEF <br /> '� �� � � UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS � <br /> OISHWASHER � VENTIIATION FAN ' <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER i WATER HEATER ' <br /> URINAL � WOOD STOVE � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DAAIN � I�IREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR, ETC.) � GAS RANGE ' <br /> � GAS PIPING � <br /> � EXHAUST FAN ' <br /> i <br /> � ' <br /> SUB TOTAL $ � SUB TOTAL S � <br /> PERMIT S � PERMIT $ � <br /> TOTALFEE $ � TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK �� REnR SET ACK / SIDE SETBAC�( �l PLAN CHE K Nl/M9ER FEE RECEIPT NO. <br /> v�� " �% ' <br /> 1���(� <br /> US NE LOTAREA VACANi51TE FEES VAIUATION FEE <br /> i <br /> 3 IlvES ❑ NO gUIL�ING iC <br /> HEIGHT LIMITPTION N0.Of DWELIING SIZE OF 9LDG?I. i <br /> UNITS p�UMBING i <br /> _� <br /> OCCUPANCV 80 OFSTOFIES OCCUPANTLOAD BASEMENT � <br /> GROUP MECHANICAL i <br /> ❑YES ❑ NO � � <br /> FIREALAfiMREO'D REASON ADOITIONALPLANCHECK <br /> � <br /> OTHER � I <br /> FIRE SPRINNLER REO'D PEASON i <br /> STATE BUILOING SURCHARC�E L ��J G � <br /> TVPE OF CONST PLANS APPROVED BY CITY OF EVERE7T PU9LIC WORNS � j` � <br /> �M LOCAL SALES � � <br /> �qTE � d�j TAl(CODE IS 3105 707AL �� <br /> _ '� _ <br /> I <br />