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APPLICATII .� FOR CONSTRUCZ�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION �, � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION Cl BUILDING ❑ MECHANICAL ❑ PLUhIBING (GYSIGN <br /> PROJECT ADDRESS <br /> �s �n - .�s� �T Evcrc-� , ��4 <br /> OWNER MAILADURESS �ITV ZIP PHONE <br /> :G� rl��r,�'a+ao ��.�r�e Ur• ccx��e�4,P�c1��13�LL9`��-3�- <br /> TENANTT� �/}� � MAI�ADDRES/S � �—CITY � <br /> ��i�!�!'//�7���7� ( (� <br /> ARCHITECTORPESIGNER MFILRODRESS / CITY ZIP HONE <br /> .��d.��n �'�lrr ig�ao ���hm��e �-u I �.t����� ��-�e��- �� <br /> 1_�����N II Y�MFILf/(/��1/ �� � ! 'i �iTY1 /VLI�IW �.�� /V�� e/y=.. ����`i!" ..�I /l <br /> MECHANICAICONTRACTOR� MAIIADOPE55 CIiV ZIP PHONE STTEUCENSE� <br /> PLUM9ING CONTRACTOH MAllA00RE5S CITY IIP pHUNE STATE UCENSE 11 <br /> CONTRRCTPRICEOFWORK n'�Q� <br /> � HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> DESCRIBE WORK ANO SOUANE FWTAGE INVOLVED �l � CONTACT PERSON AND PHONE N0. <br /> -d� � � j �� � - i,���xy� x�ly� r';� <br /> 0+1 . � . CIII (G�? ' 3���.� <br /> � � lC� s I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> vgcvoe_o uye oF euaoiNc APPLICATION AND KNOW THE SAME TO BE TRUF.AND COFRECT.ALL <br /> �},�7 �r J�.��p�� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> nV� i I I �C�! ) _ WORK WILL BE COMPLIED `.NITH WHETHER SPECIFIED HEREIN OR <br /> L�LO SCRIPTIONOFPROPER�rTY��S�HO;�WNBELOWORATfACr�nivocoaiesl NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT�Z%��2�K�]�� •r" AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> �(.�� I �, (� �OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> II 1L IY)G'll fUI�QCA.'II�nl�l V -re . PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> /� OWNER OF THIS PROPERTY TO PERF�RM THE WORK FOR WHICH <br /> /1 �S('�r ���C�Z'�d �� � 3 APPLICATION IS MADE AND I COMPLY NJITH THE STATE <br /> PARCELTA%I.D. UMBER ' �= . P�Q CONTRA TORS LAW 1827 RCW AND 296200 WAC, <br /> CONSTRUCTIONLOANLENDER.ADOFESS,TELEPHONENIIMBEF ' �, ��� � � � <br /> 51 ntU E UATE�� <br /> . CITV OUSINE55 LICENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUNE OR ITEM FEE NO. TYpE OF FI%TURE OR ITEM FEE <br /> WATER CLOSET(TOILEn � A/C—AMNDLG UNITS—H.P. i <br /> � BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. � � <br /> LAVATORY(WASH BASIN) � HEAT PUMP T <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK&DISP i CLOTHES DRYERS ' <br /> i <br /> DISHWASHER � VENT�LATION FAN � <br /> IAUNDFY TRAY ; RANGE HOOD ' <br /> i <br /> CLOTHES WASHER � WATER HEATER i <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ; GAS PIPING ' <br /> i EXHAUST FAN � <br /> i � <br /> i � <br /> i � _ <br /> i i <br /> SUB TOTAL $ ; SUB TOTAL $ � <br /> PERMIT $ i PERMIT $ � <br /> TOTAIFEE $ � TOTALFEE $ � <br /> FOFi OFFICE USE ONLY: �/�, (J�{`/1���� Z"TC�CI CU •�= 2�,� <br /> FRONT SETBACY, REAR SETBACK SIDE SETBACN PUN CHECK BEfl• FEE RECEI�NO.�/ <br /> ,Yo�C-- .�� 2 <br /> USEZONE ' LOTAREA VACANTSITE FEE:i VALUATION FEE <br /> - � ❑YES ❑ NO BUIL�ING � n� . <br /> i J i <br /> HEIGHTUMITATION NO.OFOWELUNG SREOF9LOG?.I. � <br /> UNIiS PLUMBING � <br /> OCCUPANCY NO.OFSTOPIES OCCUPANTLOAD BASEMFNT � <br /> GROIIP MECHANICAL � <br /> ❑YES ❑ NO <br /> � <br /> FIREALAflMREQ'0 REASON AODITIONALPLANCMECK � <br /> i__ <br /> OiNER i <br /> FIRE SPRINKLER REO'D REASON � . <br /> � ' <br /> STATE BIIILDING SURCHRRGE � <br /> TYPE OF CONST PUNS A'PPROYED BV CITY OF EVERETT PUBLIC WORKS � <br /> �M LOCAL SALES � <br /> onre Z� �� TAX CODE IS 3105 TOTAL ',� � <br />