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�. � <br /> APPLICATI�..� FOR CONSTRUC'i .JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STi�EcT• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION � BUILDING ❑ MECHANICAL CI PLUMBING G}-91GN <br /> PROJECT ADDRESS I I O�Q I�� �e S� �m�P /nq n,C�,.� <br /> � <br /> ONMER MAILADDflE55 CITY 21P PHONE � ����f I, <br /> 1 ����, Q <br /> ENANT W AODRES �1 CITY ZIP GHONE ��� <br /> �. IR '�`� ',� <br /> R HIIECTOR0E51GNE MAILAODRE55 CITY ZIP NE � <br /> � �jr�r���S �'a �f�� (a�-3�rn1-�A-7�-MHF33� , <br /> GENEMLCONTRALTOR AILAD�RE55 �CITV ZIP PHONE SiATELICENSE� <br /> MECHANIC0.CONTRACTOF MAILADORE55 CIN ZIP PHONE STATELICENSE• � 1 <br /> —� ; <br /> - PWMBINGCONTHACTOR MAILA��flESS CIN ZIP PHONE STATELICENSE� � . � <br /> ��'C� nC� _ I <br /> CONTR�CTPRICEOF WORK ; HEA7ING SYSTEM: ❑GAS ❑ELECTRIC ❑ � � -� <br /> I D SCRIBE RKA 50 4R FWTAGEINVOLV �• CORiACTPER50NANDPHONENO. ' � <br /> I <br /> I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS � <br /> � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> Pao D USE OF BU�.DI 0 PRO�IISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEOALDESCRIPTIONOFPROPERTYISHOWNBELOWORA7'TACH7WbCOPIES) NOT. THE GFANTiNG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �� ior BLUCK uF AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULAT:NG 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 /> PMCELTA%I.D.NUMBER CO`� TOR LAW i RCW AND 296200 WAC. <br /> _. � — <br /> CONSTi7UCT10N LORN IENDFq,pDDflESS,TE�EPHONE NUMBER x <br /> SIGNATUflE 0 TE <br /> ESS E E NO. <br /> � PLUMBIN6 MECHANICAL <br /> f <br /> NO. 7YPE OF FlXTURE OR ITEM FEE NO. TYPE�F flXTURE OR ITEM FEE <br /> � WATER CLOSET(TOILET) � AIC—AMN�LG UNITS—H.P. ' <br /> BATHTUB i FORCF_D AIR SYSTEMS—B.T.U. M E.A. i ^ <br /> LAVATORY(WASH BASIN) � HEAT?UMP ' ,_,_ <br /> SHOWER � UNIT HF.ATERS—B.T.U. M '_ , � <br /> � <br /> KITCHEN SINK&�ISP i CLOTHEiS DRYERS <br /> DISHWASHER � VENTILA710�FAN ' <br /> � LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER ' <br /> URINAL ' WOOD STOVE � �� <br /> DRINKINQ FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i _ �, <br /> FLOOR DRAIN � FIR[PLACE INSERT(WOOD BURNING) ' � <br /> i_ <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE ' <br /> � GAS PIPING .�_ <br /> � EXHAUST FAN ' <br /> � i <br /> _ i _ � <br /> i <br /> , ' <br /> � SUB TOTAL $ ; SUB TOTAL $ ' <br /> � <br /> PERMIT $ i PERMIT $ �_ <br /> TOTALFEE $ � TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SE18RC�P REAR SETBA'C`K SI�E SETBaCN PIAN CHECK NUMBEi�� FEE �yv RECEIPT NO. <br /> jv %v \/ }i y � J <br /> uSEzo L�dTAREA �ACANTSIiE FEES YALUATION FEE <br /> (� i <br /> Z � p ,S ❑YES 0 BUILCWG i <br /> HEI T LIMITATION NO.OF DWEIUNG SIZE OF 9LOGR.1. i <br /> � t� UNITS �� p�UM01NG � <br /> IIVr� <br /> OCCUPANCY NOAFSTORIES OCCUPANTLOAU 9ASEMENT MECHANICAL I <br /> GROUP <br /> ❑VES ❑ NO i <br /> FIREAURMREO'0 REASON ADUILIONRLPLANCHECK � - <br /> � <br /> i <br /> OTHER � <br /> FIRE SGRINKLER REO'0 REASON i — <br /> STATE BUILDING SURCMApuE � <br /> TYPEOFCONST PLANSAPI�VEOBY CITYOFEVERETT PUBIICWORKS � <br /> ��Y LOCAL SALES I — <br /> onre ' � TAX CU�E IS 3105 70TAL ' <br />