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� " APPLICATIC� FOR CONSTRUC7 _.�N PERMIT <br /> CITY OF EVERETT'• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> I.-i DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br /> PROJECT ADDRESS /��/ � ,,/ � <br /> � � �,� iFfl/i,T, �j.� <br /> OWNER � / MAILADORESS ,/Cltt'' c ZIP PHONE <br /> `!/.Q'�/�/.G@'1lbN /f'll/7�/.C1�— /�O/$�9�,66,dv�j�, <br /> IENANT � MAILADDI'.�S$ CI7Y ZIP PMpNE <br /> nFlCHITFCT OR DF.SIGNER M�ILADDRE55 CITV ZIP PMONE <br /> T�-�i Po�✓' �f333 � �i�- Gbi�i333 �>�3 i/�a T���ir� <br /> GENERAI CONTPAC OR MN ADDR:SS CITY ZIP PMONE STATE LICENSE� ' <br /> MFCHANICALCONTqACTOR MAILAOORE55 CITY ZIP PHONE STATEUCENSE� � <br /> PLUMBINGCON7HACTOR MAILADDRESS CITV ZIP PHONE STATEUCENSEI � <br /> CUNIRACIPNCE WORK ' <br /> +��?9o-p, �l HEATING SYSTEM: ❑ GAS � ELECTRIC O <br /> AFSCPIBE WORK ANO SOUr1RE FOOT I OWEO CONTACT PFij90N AND PHONE N i� <br /> / �S l!/,4st.Li s' cs'�i0 <br /> _ � ,J ,�/ ,-�,�� �o.J ��, �a� . � <br /> 3�� � I HEREBY CERTIFY THAT I HAVE READ AND EXAMiNED THIS <br /> PRO�OSED USE OF BUIlDIN6 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORqECT.ALL �� <br /> �.�'�� /��- PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF . . <br /> WORK WILL BE COMPLIED WITH YlHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRIPTIONOFPROPERTY-SHOWNBEIOWOqATTACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE . <br /> �or e�oce oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY � <br /> ' OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE ' <br /> _ PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOfiIZED BY THE �� <br /> '�WNER OF THIS PROPERTY TO PERFORM THE WOFK FOR WHICH <br /> APPLICAT MADE AND I COMPLY WITH THE STATE �� <br /> PARCELTA%I.D.NUMBER C ACTORS L 1827 FiCW AND 296.200 WAC. <br /> CONSTRUCTIONIOANLENOEF,A�DRESS.TELEPHIXJENIIMBER ��!(/— /��� ,. <br /> CI fY OUSINE55 UCCNSL NO. <br /> PLUMBING � MECHANICAL ' <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF FIXTURE OR ITirA FEE <br /> , WATER CLOSET(TOILEn � A/C—A/HNDLG UNITS—H.P � � <br /> BATHTUB - ; �ORCED AIR SYSTEMS—B.LU. M E.A. ; � � <br /> LAVATORY(WASH BASIN) i HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M � ' <br /> KITCHEN SINK&DISP ; CLOTHES DRYERS ; �.� <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD ; " <br /> CLOTHES WASHER i WATER HEATER i . <br /> URINAL � WOOD STOVE � �" <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WO00 BURNING) i -� <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETCJ � GAS RANGc � � <br /> GAS PIPING ' � <br /> � EXHAUST FAN � <br /> i i <br /> -- i � — <br /> i � <br /> � i <br /> SUB TOTAL $ ; SUB TOTAL S ; � <br /> PERMIT $ , PERMIT S � <br /> TOTALFEE $ � TOTALFEE $ � . <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAP S BACK SIDE SE BACN PIAN CNECK NUMOEP FEE RECEIPT NO. <br /> N/N N� �� '� :'l�' �j_,�� .. <br /> usezo �pEn VACANTSITE FEES VALUATION PEE <br /> n <br /> �.Z s,QN rLLr 4 NAyC. ❑VES fTT� <br /> BUILDING i _ <br /> i <br /> H GMT LIMITATION NO.OF DWELLM6 SIZE OF 8LM'iRl. -- � , <br /> ` �� UNITS - PLUMOING j <br /> OCCUPANCY ��OAf5i0RIE5 OCCUPANTLORD BASEMENT MECMnNICAL i � <br /> r.nour <br /> ❑YES n r+o � -� <br /> � <br /> FIRE AURM REO'D REASON ADOITIONFL PLAN CHECK j <br /> OTHER i <br /> FIFE SPFINKLER NEO'D REASON ' <br /> i <br /> STATE 9UILOING SI1RClIARGE j ' <br /> � <br /> I1'PIiOfCONSI. PI.AN$APPROVED V -- — � � � <br /> CITY OP EVERETT rumicworaKs <br /> 1111 LOCAL SALES � , <br /> oae _ 6Jj TAX CODE IS 3105 TOTAL J , ; '� <br />