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APPLICATION FOR CONSTRUGT �ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVI510N <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION fl COMBINpTION f-1 BUILDING fl MECHANICAL �l PLUMBING �'SIGN <br /> PROJECT ADDRESS //�/� /9� /j J� CC <br /> fr ✓ <br /> OWNER MAIIRODRE55 CITI' ZIP PHONE <br /> _ /�.,i�,,,�.S��s 136Yy NE' /��Pl ''��/ �F/r/w,.� �,.✓� t'4��3f� - <br /> 7ENANT MAILAOOPF.SS CITV ZIF PI�ONE <br /> f�'f�Hy��s /CYy /9 ' A� S� <br /> ARCMITECTOR�ESIGNER M0.ILADORE55 Cltv ZIP PNONE <br /> _��. �i3,�� M�/f� ����✓,� �i�z>� 3s3�-�.z� �,��E a7>DA <br /> GENERAL OYIRACTnOR1 , MAILAOORESS GIP! 21P PHONF SiqTELICENSE� <br /> /Y� <br /> MECHRNICALCONTRA iO1R� MFILADDRESS CITY 7.IP PHONE STATEUCENSE� � <br /> �ry I <br /> PWMBINGCONTRAf,TOR MAILA�ORE55 CIiY ZIP PHCrIE STATELILENSE• I <br /> � <br /> CONTPACT PRICE OF WOPs� <br /> `�pZs D� HEATING SYSTEM: f l GAS fl E�ECTRIC f-1 ' <br /> DESCRIBE WORK AND SOl1ARE F TAGE INVOLVED COYTACT FFRSONAND PNONE 60.� 3 S� �g�y I <br /> l <br /> �I �� <br /> .+-i� �� OnG f4i,c�..,l rt,om 5• <br /> I HEREBY CERTIFV THAT Y HAVE REAU AND E%AMWED THIS '� <br /> PROPOSED USE OF BUIL�ING APPLICATION AND KNOW 7HE SAME TO BE TRUE AND CORREC7.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF • <br /> WORK WILL BE COMPLIED WITH WHETIIER SPECIFIED HEREIN OR <br /> LEGALDESCPIPTIONOFPROPERTYISHOWN6ELOWORATfRCMTWOCOPIES� NOT. THE GRAPITING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> io7 e�ocK oF 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 COMPLV WITH THE STATE <br /> PARCEIT�xI.D.NUMBER CONTRACTORS LAW 7827 C 296.200 WAC. <br /> �� /�-G-�iS <br /> CONSTRUCTION LOeAN1 LEN ER,AD�RE55.TELEPMONE NUMBER x L...{j <br /> . /V SIGNFTURE �ATE , <br /> CItY BUSINESS LICENSE NO. ' <br /> � PLUMBING MECHANICAL <br /> NO. TVPE OF Fl)CTURE OR ITEM FEE NO. TYPE f.�EOUIPMENT FEE <br /> • WATERCLOSET(TOILET) � A/C—AItiNDLG"NRS—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; ' <br /> LAVAI'ORY(WASH BASIN) � HERT PUMP i <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAV ; �7ANGE HOOD � <br /> CIOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DHAIN � FIREPLACE INSEfiT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS � GASFIREPLACE ; <br /> SINK(SERVICE—BAH,ETC.) � GAS RANGE � • <br /> GAS PIPING ' <br /> i EXHAUST FAN i <br /> � i <br /> ; � <br /> � � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL $ � <br /> PERMIT S � PERMIT $ i <br /> TOTAL FEE $ _L 70TAL FEE $ ^ ; <br /> FOR OFFICE USE ONLY: <br /> FRONi SETPACK REAR SETBACN SIOE SETBALN PIAN q1ECK NUMBfR F[F RECFIPi NO. <br /> �v�� --, �- 3Sio <br /> usezor�� ,y LOTRREA VACANISIIE FEES VALUATION FEE <br /> v-f 1 I IYE$ f i NO � <br /> emion,c �L i <br /> � <br /> MEIGNT IIMITAT10N NO.OF DWELLING SIlE OF BLDGRI <br /> UNIIS PLUIdOMG � <br /> — _�'_ <br /> OCCUPANCY NO Of SIOPIFS OCCUPANT LOAO BASEMENi i <br /> GROUP MEGNANICAI i <br /> IIVES �i NO <br /> FIREAURAIREUD f1fA50N � AOpI1104aLPLANC��Ef.N i <br /> !__ <br /> OiNFR � <br /> i <br /> FIRE SPRINKLER RFO➢ REASON i �( <br /> SIDIEou�lo�NcqlncNnncE — ih�l <br /> 4/ <br /> 1YPE OF f,ON$T PIANSAPP�R VE.�9Y CITY OF EVERETT PUPI If,WORYS <br /> i �n LOCALSALES -- _ <br /> ,,,A,E �2- o�4� TAX CODE IS 3105 To7AL ' <br />