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APPLICATION FOR CONSTRUCTION PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETi,WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION i 1 BUILDING ❑ MECNANICAL ❑ PLUMBING jd SIGN <br /> PROJECT ADDRESS <br /> ONMER MAILAOURESti CIIY 71P P11UNE <br /> 1�5 �.�'w�s,��is NEe�r,r.�v �. �v�,eerr.�ua. 9sZa� 33s-o 8sd <br /> IEN�NT MAIIADORF.55 Cltt 71P PIIONE <br /> NfRXiNES RN?'i�Ui7-/ES ,� Cv 2�os . s.RmE <br /> ARCMITECTOROESiGNER MAILADDRE55 QiY � ZIP PNONE <br /> GENEHKCONTR�CTOR MNLADDRESS piY )IP PMONE SUTEIJCENSE� <br /> � <br /> MECNl1NIC�l.CONTRACTO{1 MAIL/�DDRE55 CITY 21P PIIONE STATELICENSE� <br /> 8EP-�eyn►�oN Co,O.a,BaxSZ6� <<IuuW000_url�9BaY6 . �7�-A835 r�re�2.yn►cQ77Cm <br /> PLUMBINOCONTRACTOR MAIIAUDRESS �' 21P PHONE STATELICENSE� <br /> CONTRACT PRICE OF WORK <br /> Sl NS �° HEATING SYSTEM: ❑GAS ❑ELECTRIC � <br /> UESCPoBE NqRK ANU SOUARE FOOTAGE INVOWEO 1 CONTACT PERSON AND PHONE NO <br /> � <br /> S L L (� c ' ��O '" ' <br /> U D <br /> S � 1 HEREBV CERTIFY TFIAT I HAVE READ AN� EXAMINEO 1HIS <br /> APPLICATION AND KNOW THE SAME TO BE T'RUE AND CORHECT.ALl <br /> vnoroseo use oF euaoir+a PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> WOHK WILL BE COMPLIEO WITH NMETHER SPECIFIED HEREIN OR <br /> LEO�LDESCRIPTIONOFPFIOPERT�V�cSHO�WNBELOWOR�ITACH7WOCOPIES) � NOT. THE GRANTIN6 OF A PERMIT DOES NOT PRESUME TO OIVE <br /> �oi 2 e�ocrz�[�[L_oF � s ' AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> � OTHER STATE OR LOCAL LAW RE(iULATIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTHUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THiS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> 'Xo � S7 ' O 'O APPLICATION IS MADE AND I COMPLY WITN THE STATE <br /> PAHCEL TIVI I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CON57RUCTION LOAN LENDER,�DUiiESS.TELEPNONE NUMBEA x O ' � <br /> SIGNAIUqE OATE <br /> oz <br /> CITY BUSINE55 LICENSE . <br /> PLUMBINd MECHANICAL <br /> NO. TYPE OF Fl%TURE OR ITEM FEE NO. TYPE OF flXTURE OR I7EM FEE <br /> WATER CLOSET(TOILET) � MC—NhINDLO UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> UIVATORV(WASH BASIN) � I1EAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CIOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD i <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BUHNING) i <br /> FLOOR ORAIN � FIREPIACE INSERT(WOOD BURNINO) � <br /> BACKFLOW PREVENTERS ; CiAS FIREPIACE • i <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> GAS PIPING ' <br /> i EXHAUSTFAN � <br /> i � <br /> � � <br /> i � <br /> � � <br /> SUB TOTAL E ; SUB TOTAL S ' <br /> PERMIT S � PERMIT E � <br /> TOTAL FEE S � TOTAL FEE E ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAF SETBACK SIDE SETB�CN PLAN CIIE N U BEfj, FEE_ �� NECEIPT N0. <br /> �,ic L � <br /> !�[1 <br /> useiony� AREA � V�CANTSITE FEES VALUATION FEE <br /> l_— / Z 3 7 rnes No ouuoina // . Q ;r'U <br /> HEI TLIMIiATION NOOFDWElLINO SIIEOFALDGII.I. � <br /> � UNITS PIUMHINb <br /> L iN� <br /> p��PANCV NO.OG5701UE5 VCCUPANILOAD BASEMEN� MECHRNICAL � <br /> ❑YES fl NO � <br /> �DDITION�L PLAN CNECK i <br /> FIREAUHMREO'0 REASON � <br /> OTXER � <br /> FIRE SPRINKIER REO'D REASON ' � "� <br /> STATE Ol11LDING SUBCM�RGE � �(/ <br /> TYPEOFCONST PUNSAPPROV BY CITYOFEVERE7T �UBLiCWORKS j <br /> In, LOCAL SALES <br /> DATE TAX CODE IS 3105 TOTAL � �� O( <br />