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APPLICATII..�1 FOR CON�TRUCI .ON P��iMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 C,EDAR STREET• EVERETT,WA 98201 •259-8810 <br /> f7 DEMOLITION fl COMBINATION fl i3UILDING I-I MECHANICAL f� PLUMBING fl 51GN <br /> PROJECT ADDRESS �/ <br /> //O/`� /`J'�" /"7J�_ S LC <br /> py`JFp / / 'Y MAILADDPESS CITV 21P PHONE <br /> �\�%"/�3-�� <br /> TENA�� �/ � MAILADDRESS — CITY ZIP PNONE <br /> {'\ll <br /> ARCNITECTORDESIGNE MAILII0DRE55 CITY ZIP PHONE <br /> GENEfiRLCONTR\CTOR MRI�AUORESS C�TY ZIP PHONE SIATEUCENSE• <br /> MECHANICALCONTRACiOR MPILADDRESS CITV ZIP PlIONE SiATELICENSE� <br /> PLUMBIHGCONTRACTOR MAILAODRESS CITV ZIP PHONE STATELICENSE� <br /> GONTRACT FRICE OF WORK <br /> HEATING SYSTEM: f'I GAS f-1 ELECTRIC rl <br /> DESCRIBE WORK ANO SOURRE FOOTAGE INVOLVED CONTAGT PERSON ANO PHONE NO. <br /> �C n..�i � ?-- J <br /> I HEREBY CEATIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TtiUE ANO CORRECT ALL <br /> PROPOSEO USE OF Bl11LDING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF � <br /> WORK WIIL OE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALOESCflIPT10NOFPROPERTY�SHOWNBELOWONATTACMTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> wr e�acrc oF AUTHORITY TO V�OLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTfiUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PfiOPERTY TO PERFORM THE WORK FOR WHiCH <br /> APPLICATION IS MADE P.ND I COMPLY WITH THE STATE <br /> P:�iiCELTN(I.D.NUMBER CONTRACTOflS LAW 1827 RCW AND 296200 WAC. <br /> CONSTflUCTION LOAN IENDER,AODRESS.iELEPHONE NIIMBEfl X �Z��–7 � <br /> $IGNATURE D:.TE <br /> CITY BUSINESS LICENSE NO. <br /> PLUMBING MECHANICAL <br /> - NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF�EOUIPMENT FEE _ <br /> WATER CLOSET(TOILEn � A/C—A/HNOLG UNRS—H.P. ' � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK&DISP i CLOTHES DRYERS �i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY � RANGE HOOD � <br /> CLQTHFS K�AuI IER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> ORINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GASFIREPLACE � <br /> SINK(SERVICE—BAF, ETC.) � GAS FANGE ' <br /> ' GAS PIPING <br /> ; EXHAUST FAN � <br /> i ' <br /> � ' <br /> � ' <br /> -T <br /> 1 � <br /> SUB TOTAL $ ' SUB TOTAL S ; <br /> � <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE $ ' TqTAL FEE S ' <br /> FOR OFFICE USE ONLY� <br /> f AONT SETPRCK REAR 3ETBACK SIDE SETBa�K PLAN GIIECK NUMOER FEF PECEIPT N0. <br /> a <br /> usezor+E �ornnen VACRNi51iE FE VALUATION FE_�_ <br /> ' nves r ruo omtoiNc ' <br /> � <br /> NEIGNTLIMITATION NO.OFDWELLW3 SIZEOPBLDG/TI � <br /> UNI I$ VLIIMOING <br /> �— � <br /> OCCUPANCY NO O[S�OFiES OCCUPANTLCAG BASEMENT IAF.CH�NIC�L � <br /> GRQ.:� <br /> f 1lES fl NO � <br /> FIpEAUFMREO'D REASON ��DtlIOWd.PL�NC��ECK i <br /> �— <br /> i <br /> OTIIER i <br /> FIRESPHINKIERFEO'D PEASON <br /> STn1E BWLDING SURCH�fiGE � <br /> TYPEOFCONST PL�NSAPPR"uVEDBY CITYOFEVERETT ���BLIC,WORNS <br /> LOCAL SALES — ---- �— <br /> �pTE 7AX CODE IS 3105 70TAL _20 ! <br />