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� <br /> APPLICATI4A FOR CONSTRUC? �ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION fl COMBINATION fl BUILnING I-1 MECHANICAL �� PLUMBING fl SIGN <br /> PROJECT ADDRESS <br /> /0730 19 A�� 5�= swY�f � <br /> ONRlER M�ILRDDRE55 GITY ZIP n PHONE <br /> /9.b�i IQvY S"raf+or� /NC ��� 5J �'�t7�C1� /'��,��/ dHb �c' zz zz <br /> TENANT M�IL�DORE55 GITY 2iP FHON <br /> �.,efi�s'��ie c�wrlN�/9 ia-iau /9��3EISr�p �Jvt'C� QISCzaI � c. Z.� �S <br /> Af�i HITECTOROESIGNEF MRIIADORE55 CITY 71� nHONE <br /> GENERRICONTRACTIXi � MRIUODRE55 ��CITY ZIP PIIONE SiATELICENSE• <br /> .� � �v`��P cN H.7GG J✓ LD/NN/FT„�✓ /`��O»K q�V o'� �OG '7�z B/G g'Q( <br /> ' MECHA ICRL ONTRACTOF MRIIADDPE55 CIN ZIP PHONE SIDTE UCENSE� <br /> duro�� � <br /> PI.UMBINGCONTRACTOR MAILADURESS Cltt 21P PHONF STRTEUCENSE� <br /> � CONTHACT PRICE OF WORK <br /> APP � d0��= HEATING SYSTEM: f l GAS fl ELECTRIC �l <br /> DESCRIBE N'ORK�NO SOUPRG FOOTAGE INVOLVEP CONTAGT PERSONANO PHONE NO. <br /> �� ' '. I HEREBY CeflTIFV THAT I HAVE READ AND E%AMINED THIS . <br /> � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROPOSEDUSE OF BUIIDING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF ' <br /> � � , WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �� , IEG�LDESCRIPTIONOFnROPERTY(SHOWNBELOWORATTALHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE <br /> ' •�� . ior e�wK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> - - . OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> - � � PEflFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> . OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ' OIWCELTA%I.D.NUMBER CONT �RS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTiilIC710N LOAN IENDER,AODHESS.TELEPHONE NIIMBER x /(/�� 5� I L ��^ / + <br /> � SIGNAT E DATE <br /> . CITY BUSINESS UCENSE N0. <br /> �� PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FI%TUAE OR REM FEE NO. TYPE OF EOUIPMENT FEE <br /> T— <br /> WATERCLOSET(TOILET) � A/C—AMNDLOUNITS—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � _ <br /> SHOWER � UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN ; <br /> LAUNDRY TRAY � RANGE HOOD � <br /> CLOTHES WASHER � WATEfl HEATER ' <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BUiiNING) � <br /> FLOOR DRAIW � FIREPIACE INSERT(WOOD BUFNING) ' <br /> BACKFLOW PREVENTERS i G,4S FIREPLACE � <br /> SINK(SERVICE—BAR,ETCJ � GAS RANGE � <br /> � GAS PIPING <br /> � F%HAUST FAN � <br /> i <br /> ' idL..r /S P ' <br /> ; � �< .f,, s ,r vo d, � <br /> � <br /> SUB TOTAL $ ; SUB TOTA� $ ' <br /> PERMIT $ � PERMIT $ ' � <br /> � . TOTAL FEE $ � TOTAL FEE 3 '^ <br /> FOR OFFICE USE ONLY: <br /> FRONi SETBRCN REAR SETBACN SIDE SETBACK �1AN CIIELK NOMBf:R FE[ RECFIPT NO. <br /> usezor+e tor�aEn V�CANLSIiE FEES VALUATION FEE <br /> IIYES fi NO BUILbING i <br /> HEIGHT LIMITATION NO OF DWELLING SIZE OF BLDG�fI � <br /> UNRS PIUMBING <br /> — � <br /> i <br /> OCCLIP�NCY NOOiSI0WE5 OCCUPANTlOAD BASEMENT MECII�NIC/l � <br /> GHOU� � <br /> IIYES �I NO <br /> FIRE ALAPM REO'0 RFASON MDI110NnL PIAN G1f.CK � <br /> ---�-- <br /> —_ i <br /> C1NtR � <br /> i <br /> FIRE SPRINKLEH REO'D FEASON � <br /> STFTE HUIl0IN0 SlIRC11ABGE i � <br /> TYPEOFCONST PI�NSAPPI�OVEDBY CITYOFEVERETT �'��OIIf.WORKS � I <br /> LOCAL SALES --� <br /> npTE TA%CODE IS 3105 To7Al �_ <br />