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APPL•ICATIOd FOR CONSTRUCTIiiJN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 • 259.8810 <br /> I I DEMOLITION 1 I COMBINATION I I BUILDING I i MECHANICAL PLUMBING I I SIGN <br /> PROJECT ADDRESS <br /> (� C <br /> VYNE11 MAIL IUnf.55 city 71P r4 IC <br /> �h5 5�k� 5� a �� H— a— <br /> TENANT MMLAODRESS CITY ZIP 1 PHONE �� I �Q 7� <br /> ARCHITECT OH DESIGNER M 'ADOnE55 CITY ZIP PHONE <br /> EN CONTRACTOR MgIL ADDnf.55 CITY ZIP PIGN[ STATE LICENSE <br /> L <br /> i vr�ctP�A -tP�Fnl <br /> MECHANICAL—CONTRACT MAILADDEIIESS <br /> cIIY ZIP PHONE STATE LICENSE <br /> PLUMBING CONTRACTOR MAILADORESS CITY ZIP PHONE STATE LICENSE• <br /> CONTRACT PRICE OF WINOf <br /> _ HEATING SYSTE.A: F7 OAS FI ELECTRIC fl <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED CONTACT PERSON AND PHONE NO. <br /> '�? - _ <br /> IIII M 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL DESCRIPTION OF PROPERCH TY(SHOWN BELOW OR ATTATWO COPIES) WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> Lot BLOCK DF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED DY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PA.ICEL tAX I D.NUMBER CONTRAQTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER.ADDRESS.TELEPHONE NUMBEn - — <br /> IOIIATIRE \ DATE <br /> JW— <br /> CITY GUSINE55 LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) I A/C—AMNDLG UNITS—H.P. I <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) I HEAT PUMP <br /> SHOWER ' UNIT HEATERS—B.T.U. M I <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS <br /> DISHWASHER 1 VENTILATION FAN <br /> LAUNDRY TRAY RANGE HOOD <br /> CLOTHES WASHER I WATER HEATER <br /> URINAL ' WOOD STOVE <br /> DRINKING FOUNTAIN 1 METAL FIREPLACE(WOOD BURNING) <br /> FLOOR DRAIN FIREPLACE INSERT(WOOD BURNING) I <br /> BACKFIAW PREVENTERS OAS FIREPLACE <br /> SINK(SERVICE—BAR.ETC.) I GASRANGE �— <br /> ' GAS PIPING <br /> I EXHAUST FAN —�- <br /> 1 <br /> 1 <br /> I <br /> T <br /> 1 , <br /> SUB TOTAL E ' SUB TOTAL E ; <br /> PERMIT E 1 PERMIT S I <br /> TOTAL FEE $ ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK FEAR SETBACK SIDE SETBACK PLAN CHE7 NUMBER FEE RFCEIPT NO <br /> USE LONELOTAREA VACANT SITE FEES VALUATION FEE <br /> IVA_ f1YES FT NO BUILDING <br /> HEIGHT LIMITATION NO OF DWELLING SIZE OF BLIGRI <br /> UNITS <br /> PLUMBING 2/ <br /> OCCUPANf,Y NO Or 51(miFS OCCUPANT LOM BASEMEN( s <br /> GROUP MECHANICAL <br /> RYES I I NO <br /> FIRE ALARM nFUD CASONRADDITIONAL PIAN CHECK xj <br /> OTHER <br /> FIRE SPRINKLER REOD REASON <br /> STATE BUILDING SURCHARGE O <br /> TYPE OF CONST PIANS APPROVED BY CIT/OF EVERETT PUBLIC WORKS <br /> LOCALSALES <br /> DATE TAX CODE IS 3105 TOTAL <br />