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�r ^ <br /> APPLICATIO� FOR CONSTRUCTION PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION fl COMBINATION fl BUILDING f] MECHANICAL ,� PLUMBING fl SIGN <br /> PROJECT pDDRESS /O•� � v /�J`J- � �_ <br /> . <br /> OWNER MPIL�DDRE55 CITY 21P FlHONE <br /> !q `� Ae S�f t',� /60i6 � ri��^3j�o-h�.d �ko/l Czo6� �- 88 -?.ziz. - <br /> 7ENANT MAIIADDRE55 TY ZIP PHONE <br /> �lav� Sver�S t`�ia.t lo73D • IS� Ave S,£. �re,,e,j} <br /> �RCH ECTOR�ESIG ER MPILADDRE55 CITY 21P PIIONF <br /> GENERRLCONipPGTOR lAAIIADDRE55 CIiY ZIP PHON@ STATELICENSE• <br /> �r'!�e C s� �c�bv. Se v�c.e.t /6337 -?Y��� S{ N-E. 5 �i •�,�j qK290 �"'6�33'r36�o �.•"dsC' SO�I KQ2 <br /> MECHRNICALCONTiTACTOR MAILA�DRESS CIN � 21P r� PHONE STATELILENSE� <br /> PLUMBINGCONTP....fOR M0.ILADDRESS CITV ZIP PHONE STRTELICENSE� <br /> S <br /> CONTMCT PRICE OF W K <br /> HEATING SYSTEM: GAS rl ELECTRIC rl <br /> DESCRIBE WORKAND SOUAPE FOOT�GE INVOLVED CONTACT PERSON AND PHONE N0. <br /> 3i s -F ..-� <br /> 'F� � r r ' ' �e�,,, _ <br /> �. � � I HEREBY CERTIFY THAT I HA�� READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT.ALL <br /> PROPOSEDUSE OF BUILOING PROVISIONS OF LAWS AND ORDINAhCES GOVERNING THIS TYPE OF � <br /> WORK WILI BE COMPLIED WITH WHF.THER SPECIFIED HEREIN OR <br /> IEG/�LDESCRIPiIONOFPROPEPTV�SHOWNBELOWORPTTACH7WOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NO7 PRESUME TO GIVE <br /> ior e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATIVG CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH . <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCELTA%I.D.NUMOER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRIICTIIXd LO�N LEN�ER,ADORESS.TELEPHONE NIIMBER ^ � 1 �� 7��J <br /> � SIGN�UR DFiE <br /> qTY BUSINE55 UCENSE N0. <br /> � PLUMBINf3 MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> � � WATERCLOSET(TOILET) � A/C—ARiNDLGUNfTS—H.P. ' . <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) i HEAT PUMP � <br /> uHOWER ' UNITHEATERS—B.T.U. M <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRY TRAY ; RANGE HOOD _�_ <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) 1_ <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE __T_ <br /> SINK(SERVICE—BAR,ETCJ � GAS RANGE _ ' ' <br /> GAS PIPING � <br /> i EXHAUST FAN � <br /> � � <br /> � ' <br /> � ' <br /> T <br /> SUB TOTAL $ ; SUB TOTAL $ ; <br /> PERMIT $ i PERMIT $ � <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETPRLN REAR SETBACK SIDE SETBALN PL�N CIIECK NUMBF.�j _� FEF AECEIPT NO <br /> TG1�l, J <br /> USEZONE IOTAREA VACANTSITE FEES VALUATION FEE _ <br /> IIYES fl NO i <br /> BWIDING � <br /> HEIGMTUMIT�TION NO.OPOWELLING SIZEOFBLDGRI ' <br /> � <br /> UNITS p��JM01NG i <br /> OCGUPANCY NO 0lS10AiES OCGIIPANTLOAD BASEMEN! � <br /> GRCUP M[CIIANICAL � <br /> fIVES I1 NO ' <br /> ADDI110NM PL�N CHECN i <br /> FIRE�LARM REO-D FFASON � — <br /> OTHER i <br /> FIRFSPRINKLERRFO'D RF�SON =— --� — <br /> STAIE BUItDING SUR[r1�RGF <br /> TYPE OF f,ONST PL�NS MPROVEO pY CITY OF EVEREtt ruauc wonKs i <br /> LOCAL SALES -- -�- <br /> nnre TAX CODE IS 3105 TOTAL _ ; <br />