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APPLICATIO�� FOR CONSTRUCTrJN PERMIT <br /> CITl' OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 • 259-8810 t7T <br /> I-1 DEMOLITION fl COMBINATIOfV I� BU;LDING I1 MECHANICAL f� PLUMBING fl SIGN <br /> PRQJEC?ADDRESS / <br /> .S�i���> /�"�'f- � G'� �'f�� � <br /> ��� � / / f.1�ILAf)DRE55 CITY ZIP � yf <br /> �- Y�rn�� /,��%/3 .�5�,�n//�✓� �U� Z���/R / 'oNF h/�1'i -oG ln s <br /> � �i� <br /> TENANT MAIL�O�PF55 I L � <br /> FHONE <br /> ARCHITF.CTOROESIGNER MAILAD�RE55 CITY — <br /> Z��' PHONE <br /> GENER�LCONiRACTOR h'FILADORESS CITV pIp <br /> PIIONE STFTE LIC'NSE a <br /> MEC �NICAL CONTR4CT/p{�� MFI�4�DRE55 CITV ZIP Pf10NE <br /> / �/ n� /� STATE LICENSE/ <br /> _ 1L�/�21� / /G�/�'l///�G �� <br /> IL Fl�n[aa CI�. <br /> v 21P PI{ONE STATE LICENSE d <br /> CONTRACT FRICE OF WORK <br /> HEATING SYSTEM: CI GAS ❑ ELECTRIC C7_ <br /> �ESCi110E WORK AN�S�U�RE FOOTAGE INVOLVE� CO`ITACT PERSON ANp Pf10NE NO <br /> '�-�— w r-- �: .l�� �,� ,�.�,, ��; : ��,�: _ 7,;;^� <br /> /U,f' CioC j I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF 6UILOINCo APPLICATION AND KNOW THE SNME TO BE TRUE AND CORRECT.ALL � <br /> PROVISIONS CF LAWS AN�ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALOESCqIPTIONOfPqOPERTY�SHUWN9ELOYlORqTfACHiWOCOPIES) WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOi PRESUME TO GIVE <br /> LOT __BLOCK pF AUTHOFITY TO VIOLATE UR CANCEL THE PROVISION OF AWY <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 COMPLY WITH THE STATE <br /> PP.RCE'.TAX I.D.NUASi.ER CONTRACTOHS LAW 1827 RC'JJ AND 2PG.200 WAC. <br /> CONSTRUCT70N lOAN IENDEH,A�DRESS.TEIEPHONE NUTAdER <br /> x <br /> --- SIGNFTUPE �qtE <br /> CRY BUSINESS UGENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF FIXTURE OR ITEM FEE <br /> ' WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. , <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> � <br /> LAVATORY(WASH BASIN) � HEAT PUMP --�— <br /> SHOWER ' <br /> ' UNIT HEATERS—B.T.U. M i <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS <br /> DISHWASHER � VENTILATION FAN �— <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE � <br /> _ DRINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR, ETC.) GAS RANGE <br /> � <br /> ; GAS PIPING � <br /> � EXHAUST FAN � <br /> , —� <br /> � <br /> i � <br /> SUB TOTAL 5 ; SUB TOTAL 5 ' <br /> PERMIT S � PERMIT S � <br /> TOTALFEE S � TOTALFcE S � <br /> FOR OFFICE USE ONLY: <br /> FqONTSETBACK REAR SETBACK SI�E SETBACH PLANCH�C�,UgE� FEE <br /> �/ � RECEIPTNO. <br /> � <br /> usezoNe �prpaen vncnNiSire FEES VALUATION FEE <br /> __ f1VE5 ❑ NO BUILDIKG � T— <br /> HEIGNTUMITFTI04 NO.OFCW@LLING SIZEOF�L�G/TL � <br /> UNITS <br /> PWMOING i <br /> i <br /> OGCUPANCY NO OF Si0RIE5 OCCUPFNT LCAO BASEMENT -I— <br /> GflOIIP MECH4NICAL � <br /> ❑YES fl NO � <br /> FlREALARMREO'0 PEASON FD�IPONALPLANCHECK � � I �,_�� <br /> OTHGR �� I � � i�� <br /> FIRE SPRII;;(LR P.EO'O REAcON �.l-'// � ' <br /> _ STFTE 91111�ING$MCMFRGE � <br /> 1YPEOFCONST PLANSA',FFOVEDBV CITYOFEVERETT PUOLiCVfORKS ' <br /> �� � l TAX CODE S 3 05 TO7nL ' <br /> onTe �a2 9� • ; <br /> �.�� ���U-� <br />