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APPLICATI(od FOR CONSTRUC? mON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259.8810 <br /> 11 DEMOLITION I I COMBINATION I I BUILDING ' I MECHANICAL 11 PLUMBING i I SIGN <br /> PROJECT ADDRESS <br /> o in o 1 1 <br /> OWNER MAIL ADDRESS CITYCITY1 I <br /> F-ver u T 2(. L' Pu'+ L w •( IIo Jr <br /> �.n `/o sL F ozz o Kr_A Po 1-5 0.• rl S !•c 2. 3 vfI-CA. <br /> TENANT /� MAIL ADURF.55/I ' rin IIP ,A PHONE <br /> IV G,l'k S CL •� CSI" $4wt 4 ) Prd 'tTJ—��K F� G 1 (� 9(7( 7 <br /> AnCHITF.CT OR DESIGNER MAII ADDRESS CITY ZIP PNONF <br /> NA <br /> GENEnAt CONTRACTOR MAIL ADDRESS CITY lip PHONE 9 T LICENSE <br /> LO-A b..td- <br /> MECIUNICALCONTRACIOR MMI ADDRESS CITY ZIP PHONE STATE LICENSE <br /> PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSE• <br /> CONTRACT PRICE OF WORK — <br /> ,jD!90 HEATING SYSTEM: I I GAS 1-1 ELECTRIC f-I <br /> UE ScnIBE WORK AND SOUABE FOOTAGE INVOLVED CONTACT PFRSON AND PHOIIF NO <br /> t l <br /> o,., w U S C <br /> 4" g � � G I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PnOPOSEDUSE OF BIIII I APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> .F.�. •s l �. �1.� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDEscmrnoNorPRoPERre(SHOWN BELOW ORAPTACHTWO COPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT BLOCK or_ AUTHORITY TO VIOLATE OR CANCEL THE PRr••'SION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONS' ; 'TION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AU1.,-AIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> PAncEI TAXI To NUMnin CONTRACTORS LAW iB 27 RCW AND 296.200 WAC. <br /> CONSTRUCTION I DAN,rNnFn ADDRESS.TFLEPIIONE NUMBER X <br /> SIGNATURE DATE <br /> .3j <br /> CITY BUSINESS LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) , AIC—AMNDLGUNITS—H.P. , <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 , <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS ) <br /> DISHWASHER I VENTILATION FAN , <br /> LAUNDRY TRAY RANGE HOOD <br /> , <br /> CLOTHES WASHER I WATER HEATER , <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) , <br /> FLOOR DRAIN ' FIREPLACE INSERT(WOOD BURNING) , <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERVICE—BAR.ETC.) I OAS RANGE , <br /> ' GAS PIPING ' <br /> EXHAUSTFAN <br /> I , <br /> I , <br /> I , <br /> I I <br /> SUB TOTAL f ; SUB TOTAL f ' <br /> PERMIT f _ PERMIT f , <br /> TOTAL FEE $-r TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FnONT.SPTBACK BEAR SETBACK SIDE SETBACK PIANCHECKNUrn FEf w� j RECFIPT NO <br /> 7 UI ' ct <br /> USE ZONE TOTAREA VACANT SITE FEES VALUATION FEE <br /> AYES I1 NO BUILOINC �i G <br /> HEIGHT LIMITATION NO OF DWELLING SIZE OF BLI%iT .•// <br /> UNITS <br /> PLUMBING <br /> occurANCV I NO 04 SHIRTS OCCU-NIL AO BASEMENT � MECHANICAL <br /> LIRE AIAnM RE00 it ASCN I ADDITIONAL PLANCHF.CK <br /> E QST OTHER I <br /> fIRf.SPRINNI F.R REO'D RF ASpI <br /> 157 - S TATE BUIL DING SURCHARGE —v <br /> TrrEOFroNST Do ANS APINK] + I CITY OF EVERETT Punl¢Woms j <br /> V /`ILOCAL SALES --+— <br /> DATE L5 cj, TAX CODE IS 3105 TOTAL <br />