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�, —� <br /> ' r f�, <br /> C APPLICATIG�� FOR CONSTRUC7 _ Jid PERMIT <br /> � G!! CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8010 <br /> ❑ DEMOLII'ION ❑ COMBINATION f BUILDING O MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS � � ,�U I�I j_�.� �� `,` � R 'GC� �,/1 <br /> � � �r <br /> pW���q� 1hILADDRESSI F/�N �/ �, PHO E � � � // <br /> / /i'.I C—O ��,C�/1 �i.� � �� L��LF��l/�f� l '���'�i � �flC,/II�G�CZG/ ��/�1C'(r.i <br /> TEN�NT— MAILA�Of�ES°. CIN 21P PHONE , ' <br /> ARGHITEC OR O.S GNER IAhIL ADOAE$$ CITV � ZIP PlIONE <br /> �S �o �G,, ' ./.SSoc.iu{�c ��S�D f�cc' /��c�uy S SPulI`� ��'/�� 87�- `// 7�i <br /> GEI!�gALC9�TRAC' MAILA�OAESS LITV P PHONE STATELICENSE4--' <br />, <br /> /'�Pi7"���� ��iYY/l.E'�2 i?� 3,�'74 . <br /> MFf,HA>IICALCONTRACTOR MAILAODRESS CITV ZIP PkIONE STATELICENSEY <br /> PlUM01NGCONTRACTOR MAILADDRE55 CITY ZIP PHONE STATELICENSE+I <br /> CONTRACT PRICE OF WORN �v(—/ <br /> %�: _ � �UO — HEATING SYSTEM: GAS �ELECTRIC ❑ <br /> UESCflIBEWORKAND50UAREFOOTAGE NVOLVED ' �� �� COYTACTPfRSONANDP110NEN0.� %�/'�/�` �� � ��� <br /> � , � . <br /> � r <br /> ���- � - f � ,� i- zn�e � � � � ) , � <br /> � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> i �� - � APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRFCT.ALL <br /> PR�90SED j15E F BUIL N� `� I�i Q PROVISIONS OF LAWS AND ORDINANCE5 GOVERNING THIS TYPE OF <br /> //1�.�'i/C�(�//�/C( � r1Y� <�('c^^•\ � �I(,�^�� " � WORK WILL BE COMPLIED WITH WH'=fHER SPECIFIED HEREIN OR . <br /> LEGaL0E5CRIPTIONOFPfiOPERTV(SHOW 9ELOWORATfACHTWOG PIES) NOT. THE GRANTIIJG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or _o�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVIS�ON OF ANY <br /> i � , �� ��� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � ��M/� ��Q�� �� C;��� .� �.'��%� PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I t;OMPLY WITH THE STATE <br /> PAflCELTA%I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 96200 WAC. <br /> //�� '//1 /— � i <br /> CONSTRl1CTI0N LOAN LENDER,ADDRESS.TELEPHONE NUAI9ER X /�/'"/ // �/ �`/��/� <br /> SIGNATURE � DATE <br /> � �L, ��. CITY BUSINESS LICENSE N0. <br /> / <br /> PLUMBIN MECHANICAL <br /> TYPE OF FIY.TURE OR ITEM FEE N0. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) i HEAT PUMP � <br /> SHOWER ' UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP ' CLOTHES DRYERS � <br /> � <br /> OISHWASHER � VENTILATION FAN ' <br />, LAUNDRY TRAY ; RANGE HOOD � <br /> � CLOTHES WASHER � WATER HEATER ' <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVEN7ERS i GAS FIRFPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE ' <br /> � GAS PIPING � <br /> ; EXHAUSTFAN ' <br /> _ i <br /> i <br /> I i ' <br />� � � I <br />� SUBTOTAL 3 � SUBTOTAL S ; <br /> PERMIT 5 � PERMIT 5 � <br />� � TOTAL FEE $ ' TOTAL FEE $ '_ <br /> FOR OFFICE USE ONLY: <br /> FPONTSETBACK REARSETOACK SI�ESETBACK PLANCNEC�MO R) FEE RELEIPTNO. I <br /> [G"G <br /> I use zoNe LOT PREA VACANT SITE FEES VALUATION FEE <br /> �3 �' 3 ' <br /> nrEs ❑ No om�oiNc — I <br /> i � <br /> HEIGIITLIMITATION NO.OFDWELLING 512EOfyLDGR.I._ i <br /> UNITS ��� �.G. P�UMOING � <br /> OCCUPANCY NO.OFS70FIES OCCI�PANTLOAO BASEMENT � <br /> MECHANICAL i <br /> G PI ]�� <br /> "�- ❑YES .[tV'�0 i <br /> FIREALARMAR�EO'0 RFASON ADDITIONALPLAtJCNECK � <br /> /VV ' <br /> OTIIER � <br /> FIRE SPRINKLER REO'D RE.450N i/ i '7` <br /> N/� STATE�UILDINGSURCHARGE �/ ���C.� <br /> (J <br /> TYPEOPCONST. PIANSAPP�r.p1v�oev CITYOFEVEAETT ruAucwoeKs I, <br /> '-"�`� V� TAXCODEIS3 05 TOTAL ' <br /> onre 7� <br /> Cj <br /> ; �;J� , , <br />