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APPLICATi4� FOR CONSTRUCT. )N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•E�'ERETT, WA 98201 •259-8610 <br /> DEMOUTION ❑ COMBINpTION ❑ BUILDING ❑ MECNAWICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: /O�I.Z'� /5 y` �),�P S�' <br /> OIM�IER MiVLIi[NN1E55 GIIY ZIP PNONE <br /> � �Fw ,�`� � ;- im�r� s� i=�� ��o� ��sa-z�W <br /> TEh�NT MNIMDRE55 - pITY 71P PIIONF <br /> ARLNIT[CT OR OESIGNER /MIL AOM1E55 �IIY Im PHONF <br /> CENEMI.CONTMCTOR f MAILADDPE55 �ITY 11P PIIONE SIATEUCENSE� <br /> �u��+�u �wk`I�x� /7/S %�)'��� F� �A''1CS�' r33�.21I�� GAFFA1C2104/.�� <br /> i� CNANILILLCONT �CTOiI MAILADDRESS Cltt ZIP PNONE STATELICEWSE� <br /> PLUMBINGCONTMCTOR MMLADDRE55 �Itt ZIP PNONE STATEUCENSE• �� <br /> CONTMCT PPoCE Oi MIORK ��. <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ I <br /> OESCRIlE MqPK WO SIXIARE FOOTA6E N/VOWGD CONT�CT VERSON AND VNONE/q. i <br /> I HEREBY CERTIFY THAT 1 HAVE READ AND E%AMINED THIS <br /> APPIICATION AND KNOW THE SAME TO 8E TRUE AND COHHECT ALL <br /> VROPOSED VSE OF&lllplq PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF �� <br /> WQRK WILL BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br /> LEGIILOESCRIPTIONOFWWPERTY(SIWWqBELOWORATTACNTWOCOPIE$) NOT. THE ORANTIN6 OF A PERMIT DpES NOT PRESUME 7'O OIVE <br /> �or e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY �� <br /> OTHER STATE OR IOCAL LAW AE6ULATINO CONSTRUCTION OR THE � <br /> PERFORMANCE OF CONSTRUCTION.THA71 AM AUTMORIZED BY THE <br /> OWNER OF THIS PROPENTY TO PERFORM THE WOHK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCELTNf I.D.NUMBER CO ACTORS LAW 1827 C�qJJD 296200 WAC. <br /> CONSTIiUCTIfMJ LOMI LENOER.AOOIIESS.TE4EPNONE NUMlER x .(j �y 'v� <br /> 5 AT E (j / j U�TE <br /> i ! <br /> CITY BUSINE55 LICENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FlXTURE Op ITEM FEE NO. TYPE OF EGUIPMENT FEE <br /> WATER CLOSET(TOILE� � /VC—NHNDLG UNITS � <br /> BATHTUB ; FORCED AIR SYSTEMS ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNITHEATERS � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS ; <br /> � DISHWASHER � RANGEH000 � <br /> � LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOODSTOVE � <br /> . URINAL � METAL FIREPLACE(WOOD BURNING) ' <br /> DRINNIN6 FOUNTAIN { FIREPLACE INSERT(WOOD BURNING) � <br /> � ROOR DR/UN � OAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GAS RANGE ; <br /> SINN(SERVICE—BAR,ETC.) � GAS PIPING � <br /> IXHAUST FAN ' <br /> � <br /> i i <br /> — � � <br /> i � <br /> SUB TOTAL S ; SUB TOTAL S ; <br /> PERMIT S � PERMIT S � <br /> � TOTAL FEE S ' TO7AI.FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SE78ACN PEM SETBACK SIDE SETBACN PIAN CNECN NUMBER iEF RECEIPT NO <br /> :i 20 90 <br /> USE 20NE LOT AREA VAC�NT SITE FEES VALUATION FEE <br /> ❑YES ❑ NO BUILDINC � <br /> HE16HT LIMIT�TION NO OF DWELLIN6 SIZE OF BLDOR.1 - � <br /> VNIfS - p�pqBMG i <br /> � <br /> Q�COpANLY Np piSfpqFS OCCUPANTLOAD BASEMENT MECNeNICAI � <br /> ❑YES ❑ NO —"— � <br /> FIRE SPNINKLEfl PEO'D BE�SON ADDI IIONA(PLAN CHF.CK i <br /> OTHER � <br /> � <br /> FIREMMMREO'0 HEAFON � <br /> STAIE Bl11lDINC SURCN�BGE i <br /> �" r� <br /> 1YPEOFf,ONST PLnNSMPROVEDBY CITYOFEVERETT PIIBIIf,WORKA ' <br /> LOCAL SALES —�— <br /> o�re TAX CODE IS 3105 TOTAL � <br />