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APPLICAT14.1 FOR CONSTRUCT .JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> ❑ DEMOLITION fl COMBINATION f-I BUILpING ❑ MECHANICAL ❑ PLUMBING SIGN <br /> PROJECT ADDRESS <br /> �ioiy �5 � ,�� sc <br /> OWNER/�� �) MAILAD�RESS Cltt 21P PHONE <br /> -Cf17�—�{Fl,.� �/1 2� . /?!'2 V / i er �. <br /> TEIIANT MAILA�Dq CITY ZIP f'HONE <br /> ,(�.S/c.l, -�v5.�,h5 //o�d lS1t��r [.' E✓���?f 9�r�3' --^__ <br /> AR:THIT�ECT�ORO/ESIGNER MRILRDORE�S}S,/� /� GIIY 21P PHONE �M "— <br /> -.Ff�W[,J L/C lI�/"/uR.� �a .�^"� ��i�lC� /0��� 35S-v�'�2y --f-� '��C-/ `�� <br /> GENER CONTBACTO MAILADORE55 � CITV ZIP PHONE STATELICENSE� <br />► /�V/,�1 <br /> MECHANIf,p�CONTflA 0 MAILADDRE55 G7Y ZIP PHONE STATELICENSEI <br /> �Ji,� <br /> PLUM0INGCONTRACTOR MAILADORE55 CITY ZIP PHONE <br /> t1 J � STATE LICENSE r <br /> ��V <br /> CONTRACT PRICE OF WORK � <br /> �f SOD HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> OESCRIBE WORK AND SOUARE FOOTAGE INVO WED CONTACT PERSON FND PNON`E NO. /' {� `, - <br /> n'C `nihrra.'t ��-�cJ..ZJ <br /> �5�1f ont 13�9rX ����� 5, — <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF 9 ILDING APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL ' � <br /> /N���/;� _�.- ��� ( PROVISIONS OF LAWS AND ORGINANCES GOVERNING THIS TYpE OF <br /> LEGALDESCRIPTIONOFPqOPERTV�SHOWN9ELOWOFATfRCHTWOWPIES) WORK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PEFMIT DOES NOT PRCSUME TO GIVE <br /> �oT BLOLK or- AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE 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 /> PARCELTA%I.D.NUMBER CONTRA�S LAW 1_�D 296200 WAC. <br /> G <br /> CONSTRUCTION LOl�N LENqER.ADURESS.TELEPNONE NUMBER �//C_ �� I <br /> _ NiA SIGNATURE <br /> DATE <br /> d��'�3 9 <br /> CI1V B1151NES5 LICENSE N0. <br /> PLUMBIN6 <br /> MECHANIQA�. <br /> NO. TYPE OF FIICTURE OR ITEM FEE NO. TYPF OF FIXTURE OR ITEM PEE <br /> • WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. , � <br /> BATHTUB ; FOqCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) ' <br /> � HEAT PUMP � <br /> SHOWER � uNITHEATERS—B.T.U. M i <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS � <br /> DISHWASHER ' <br /> � VENTILATION FAN � <br /> LAUNDRY TRAY ' RANGE HOOD 1— <br /> CLOTHES WASHER ' <br /> � WATER HEATER , <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) ' <br /> � <br /> FLOOR DRAIN � FIREPLACE�NSERT(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 /> � <br /> SUB TOTAL $ i SUB TOTAL $ <br /> PEfiMIT S � PERMIT $ � <br /> TOTALFEE S � TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETOACN REAR SETBACN SIOE SETBACN PIAN CHECN NUMOEfi FEE RECEIPT NO. <br /> USEZONE �/O �� � <br /> toraeEn VACPNi51TE F@ES VALUATION FEE <br /> f7YE5 ❑ NO pUILDING 71 � <br /> NEIGHT LIMITATION N0.OF OWELLING SIZE OF BLDG/CI. - <br /> (/ � � <br /> UNITS <br /> PLUMBING i <br /> i <br /> OCCUPANCY NO OFSi0RIE5 ^�CJPANTLOAD B0.5EMENT i <br /> GROUP MECMANICFL <br /> ❑VF.S I'7 NO <br /> i <br /> FIREAURMREO'U FlEASON ADDIiIONFLPLANCMELN i <br /> i <br /> � <br /> OTHER � <br /> FIRE SPRINKLER REO'0 REA£ON i <br /> STA7E DOILDING SURCHARGE �L„ <br /> ta/ <br /> TYPEOFCONST PlANS PPROVEDBY CITYOFEVERETT PUBLICWORKS � <br /> � M / LOCAL SALES ' <br /> DATE � ���j� TAJ( CODE IS 3105 TOTAL l— � � <br />