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ApPLICATI� FOR CONST�iUCY'�JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br />' 3200 CE�AR STREET• EVERETT,WA 98201 •259-8810 <br />� ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL �1 PLUMBING ❑ SIGN <br /> PROJECT ADDRESS <br /> /D730 �� 5 E Sw.�T <br /> OYMER '� MAILAUURE55 CITV 21P � � <br /> PHONE <br /> I9'� f/u-� ��l � ,'7, _ 1 - ��,1 .) �!J <br /> .�� �/��� T7� �`'f pHONE <br /> I MAILADORE55 ��� Z�P <br /> TENANT <br />� � � ' oHONE <br /> p MITECTORDESIGNER MAILADDRESS <br /> CIN Z�P <br /> GENERALCONTRRCTOR MAILRDURE55 <br /> CITV 21P PNON� STA7EIJCENSE� <br /> ��ry Z�p PHONE STATE LICENSE• <br /> MECHANICALCONTRRCTOR MAIIADDRE55 <br /> ��n, Z�p PHONE $TATELICENSE� <br /> PLUMBINOCONTRIICTOH MAILADDRESS �O <br /> 2� <br /> cor+Ta�c PR oFw«+K HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> OESCRIBE WOAKAND SOUARE FOO7AGE INVOLVED <br /> CONTACT PERSON AND PHONE NO. <br /> I HEREBY CEFiTIFY THAT I Hi:JE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PR seo e oF eui�wr+c� PROVISIONS OF LAWS AND ORDINANCES 60VERNING THIS TYPE OF <br /> J <br /> �S� . WORK WILL BE COMPLIED WITH WF!ETHER SPECIFIED HEREIN <br /> LEQ�LDESCRIPiIIX'10FPROPE�1�'ISHOWNBELOM�ORATTA�HTWOCOPIES) AOTHO TY TOTVIOLA EAORRCANCEETHE PROVISION OF AINY <br /> ior BLOCK � OTHER STATE OR LOCAL LAW REOULATIN�CONSTRUCTION OH TFIE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORiZED BY THE <br /> APPL CAT�IONH'SP MADE AND PERCOMP YHEWIT�H KTHE STATE <br /> XONTRPCT9R5 LAW 182�ND 296200 WAC. <br /> PpRCELTAXI.D.NUMBER ����� <br /> �/`^� O� -r <br /> ' i0 -,3/-4l�. <br /> CON57RUG7�ON LOAN LENDEil.PUDRESS,TELEPHONE NUMBEH 516NATURF�-� �p� <br /> CITY BUS�HESS LiCENSE N0. <br /> PLUMBIN6 MECHANICAI �E <br /> �E ryp, TYPE OF FlXTURE OH ITEM �� <br /> � NO. TYPE OF FlXTURE OR REM � <br /> � WATER CLOSET(TOILEn � NC—A/HNDLG UNITS—H.R <br /> . � P'JRCED AIR SYSTEMS—B.T.U. M E.A. <br /> � BATHTUB � F1EAT PUMP � <br /> LAVATORV(WASH BASIN) , UNIT HEATERS—B.T.U. M � <br /> SHO�MER � CLO?HES DRYERS ' <br /> KR�HEN SINK 8 DISP ' ' <br /> DISHN.'.>SHER � VENTILATION FAN � <br /> � RANGEHOOD ' <br /> LAUNDpY TRAY � WqTEP HEATER � <br /> CLOTHES WASHER , WOOD STOVE '�� <br /> URINAL , � <br /> � METAL FIREPLACE(WOOD BURNINO) ' <br /> DRINKINO FOUNTAIN ' ' <br /> � FIREPLACE INSERT(WOOD BURNIN6) <br /> � FLOOR DRAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ' ' � . <br /> , ( OAS RANOE , <br /> SINK(SERVICE—BAR,ETC.) , ppS PIPING <br /> ; EXHAUSTFAN � <br /> � F � <br /> � � <br /> � � <br /> i <br /> SUB TOTAL S ; SUB TOTAL S � <br /> PERMIT 5 ' <br /> PERMIT $ ' TOTAL FEE S 30 ' . <br /> TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: FEE RCCEIPTNO. <br /> PUN CHECN N�BE � . <br /> FRp���p�K REM SET9ACK SIDE SETBACN l�� <br /> FEES VALUATION FEE <br /> USE 20NE IDTAREA VACANT SIiE ' <br /> ❑YES ❑ N� BUILOING <br /> � <br /> HEIGHT IJMITATION NO.OF�WEWNG SIZE OF 61IX3R.�. p�UMBING �OD <br /> UNITS <br /> BASEMENT MECNFNICAL '-'�� � OJ' <br /> p��p��y NO.OF STOidES OCCUP�NT LOR� i <br /> OROUP ❑YES ❑ NO � <br /> ADDITIONAL PUN CHECN � <br /> FlPEAURMFEU'D RE�SON <br /> OTHEA � <br /> i <br /> REMSON � <br /> FIRE SPR�NKLER REO'D STA7E BUILDING SURCHARGF <br /> TlPEOFCOPoSL PLANSAPPROVEDOY �m/OFEVEREIT FUBLICWORKS � <br /> LOCAL SALES /� � Dd <br /> onTe <br /> TAX COUE IS 3105 TOTAL <br />