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� _ <br /> APPLICAT14�1 FOR COI�STRUC7 .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT.WA 98201 •259-8810 <br /> ❑ DEMOLITION fl COMBINATION fl BUILDING Cl MECHANICAL rl PLUMBING fl SIGN <br /> PROJECT ADDRESS //D�� /�,�c. /IJ� S�C <br /> %7 <br /> p� / � MAILADDRESS CITY 21P PMONE <br /> / <br /> ii-t�a <br /> TENANT MAILAUDflE55 GITY ZIP PNONE <br /> ���r nl��� _ . <br /> ARCHITECTORUESIGNER MAILADORE55 CITY ZIP PMONE <br /> 6ENER�L CONTMCTOR MAIUDOHE55 CI1Y ZIP PIIONE STATE LIGFNSE� <br /> MECHANIC0.CONTFAC70P MAILADDRE55 CIN ZIP PNONE STATELICENSE� <br /> PIUMBING CONTRAf,TOR MAIL PDORESS Cltt ZIP PHONE STATE IICENSE� <br /> CONTMCTPRICEOFWORK HEATINGSYSTEM: fIGAS CIELECTRIC fl <br /> DESCPIBE WOFiN AND SOUARE FOOTAGE INVOLVEU CONTACT PERSONANU PHONE NO. <br /> l.l n..�/ ' � �- �.S — <br /> I HERF..BY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT.ALL <br /> PROFOSEDUSE OF BUIIDING PROVISIONS OF LAWS AND ORDINANCES GOVERN�NG THIS TYPE OF � <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> IEG�LDESCRIPTIONOFFROPEATY(SHOWNBELOWORARACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT eiocK oF AUTHORITY TO VIOLATE OR CANCEL THE PFiOVISION OF ARY <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br /> PEHFORMANCE 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 /> CONTRACTQRS LAW 18.27 RCW ANU 296.200 WAC. <br /> PMCELTAX I.D.NUMBER <br /> CONSTRUC7�ON LO��'LENDER.PDDRESS.TEIEPHO:�E NUMBER /�-`� _�� <br /> SIGNATURE DATE <br /> CITV BUSiNE55 UCENSE N0. <br /> PLUMBIN6 MECHANICAL � <br /> NO. TYPE OF FlIRURE OR ITEM FEE NO. TYPE OF�EOUIPMENT FEE <br /> WATERCLOSET(TOILE'� � A/C—A/HNDLGUNRS—H.P. ' . <br /> FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> dATHTUB � � � <br /> LAVATORY(YJASH BASIN) � HEAT PUMP . � i <br /> SHOWER ' UNIT HEATERS—B.T.U. M � � <br /> � ' CLOTHES DRYERS � <br /> KITCHEN SINK&DISP � <br /> VENTILATION FAN ' <br /> DISHWASHER ' — � <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATEfi ' <br /> URINAL <br /> � WOOD STOVE � <br /> ' METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAII� � <br /> � FIREPLACE INSEflT(WOOD BURNING) ' <br /> FLOOR DRAIN � <br /> BACKFLOW PREVENTERS ; GASFIREPLACE � <br /> ,3 SINK(SERVICE—P4R.ETC.) � GAS RANGE ' <br /> � GAS PIPING � <br /> ; EXHAUST FAN ' <br /> � <br /> i <br /> � <br /> i � <br /> � <br /> � <br /> � <br /> SU8 £OTO,I S � SUB TOTAL E � <br /> PEH'iAl7 $ i PERMIT $ �_ <br /> TOTAL FEE S ' TOTAL FEE 5 `_ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACN REAR SETBACK SI�E SETBACN PLAN CIIECK NUMBER <br /> FEF. RECEIPTNO. <br /> (%�3 <br /> USEZONE LOTAREA V�CANi51TE FEES VALUATION FEE <br /> � f1vE5 fi NO ' <br /> BUIl01NC � <br /> HEIGNT LIMITATION NO OF DWELLING SIZE OF OLDGRI. � <br /> i <br /> UNIIS p��)MpING � <br /> � <br /> �� � <br /> OCCUPANC:��Of S�OAIES OCCU�'ANT LOAD BASEMENT MECIIANIGAL � <br /> i <br /> GROUP � <br /> f1YES Il NO � <br /> AOpI710N�L PLAN C��l:CK � <br /> FIRE hLARM REO� �IEASON ��-�- <br /> i <br /> i <br /> OTHER ' <br /> FIRE SPPINKLER REO'D RF�SON � <br /> i <br /> STAiE BUIlf11HG SURCII�RGE � <br /> T� <br /> TYPEOFf,ONST PLANSA�PROVEOBV CITYOFEVERETT rueur.wonKs <br /> LOCAL SALES ; <br /> oATE TAX CODE IS 3105 70TAL <br />