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APPLIC,�Ra71G.� FOR CONSTRUC?.�N P�RN11T <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETf, WA 982U1 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ DUILDING � MECHANICAL fl PLUMBING Cl SIGN <br />/`tp / Z.,.Y'��j rtGh Wa^�1 <br />JE�� _ / `���ADORESS CI7V <br />n �'� /�e �w � � �rooi <br />CIiY 21P <br />"�so <br />PHONE <br />'vo Y <br />ARCHITECTOROESIGNER MAILADORE55 CIN ZIP PNONE <br />GENERALCONTPACTOR MAILr1DORE55 CIiY ZIP PHONE STqTELICENSE� <br />yV��3Gj Oov � <br />OESCRIBE WORR ANp SOUARE FOOTAGE INVOLVED <br />cirv zir <br />�l5 L, n�Nc � <br />��N Z <br />OR AT�ACH TWO COPIES) <br />l0T _ 6LOCN <br />� <br />CONSTRUCTION LOAN LENOER, AOIlRESS. TELEPHONE NUMBER <br />PLUMBING <br />NO. TYPE OF FIXTUHE OR ITEM <br />WP.TER CLOSET (TOILE"� <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DI: <br />DISHWASHER <br />LAUNDqYTRAY <br />CLOTHES WASHER <br />URINAL <br />FLOOR DRAIN <br />BACKFLOW PREV[NTERS <br />SINK (SERVICE — BAR, ET <br />FEE <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN REAq SETOACK <br />USEZONE ILOTARF.A <br />HEIGHTIJMITATION NO.OFOWELLING <br />UNIiS <br />OCCUPANCV NOAFSiORIE> OCCUPANTLOAD <br />GNOUP <br />FIREALAP.MREO'D REASON <br />SIOE SE?DACN <br />PI{ONE <br />�,_ <br />HEATING SYSTEM: ❑ GAS ❑ EI.ECTRIC ❑ <br />CONTACT PERSON ANO PlIONE NO. <br />Y <br />. <br />I HEREBY CERTIFY� THAT I liAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl <br />PROVISIONS OF LAWS AND ORDINANCES GOVEPNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THF <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEH OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA �TORS LAW 78.27 RCW AND 296.200 WAC. <br />x _ � J��'�-�� <br />SIGN URE DATL <br />CITV BUSINESS LICENSE NO. <br />NO. � TYPE OF FI%TURE OR ITEM � FEE <br />9 A/C—NHNDLGUNITS—H.P. /D <br />HEAT PUMP <br />UNIT HEATERS — E <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPIACE ( <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL 5 /O <br />PEFMIT 5 /S <br />TOTAL FEE 5 � i <br />PLAHCHECKNUTAJ�P � I fEE � RECEIPTNO. <br />VACFNT $ITE �c�� <br />f.7VES fl NO p�ILDING <br />SIZE OF BLDG/f I. <br />PLUMAING <br />BASEMENT MECHANICAL <br />❑VES il NO <br />ADDITIONAI PLAN CHECK <br />OTHER <br />STAT[ �UIL�ING SURCHFflGE <br />CiTY OF EVERETT PUBLICI'fORKS <br />LOCAL SALES - <br />l'AX COOE IS 3105 TOTAL <br />