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APPLICATIOr�I FOR CONSTRUCTrON PERMIT <br />CITY OF EVEHETT • BUILDING DIVISION <br />3200 r,EDAR STREET • EVERETT, WA 98201 • 259-8810 <br />CI DEMOLITION fl COMBINATION I� BUILDING I�` MECHANICAL �� PLUMBING f-1 SIGN <br />PROJECT ADDRESS ala r.' n P i✓'Jro� d,/o, C <br />_ i�i�s rfnf"�, C ��H- G�e %�a�,�" �% y9jo �'er�-re�� �� �v�i*�11, t.✓I! 9�aoj <br />owne �+G7 �yah�C /✓b'�'�"ooaess cirv zm PHONE <br />,T�t� Orr�m�fiet /C�.s �i�ur� ��E %u�w, � ,�! %�'/8p � 75-8 � o� <br />O f „ � <br />�ARCH TECT OR <br />� CITV ' 21P <br />'� �uP!/rEP/I /�y C(/P� C1. <br />%�«� ; CG�str, S �f�,r,�.r �7�73 //6 �k,fi,r.NE <br />MECNANICAL CONTR�CTO MAII A�pRE55 <br />Cin i fKi J'�/.ftr,� s.,%c _/GZ /.l'cd. �/��,� f�; <br />PLUMBINGCON ACTOR MAIIFDDPESS <br />CONTRACT PRICE OF WORH ����� <br />OESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />PROPOSEO USE OF BUILOINp <br />LEGRL DESCFIPTION OF PROPERTY (SHOWN AELOW OR ATTACH <br />LOT' BLOCK OF <br />PARGEL T/�%�✓ NUMB� ^G� � _ /,^O�_ <br />2u w <br />CONSTRUCTIONLOANIENDER,ADDRESS.TELEPHONENUMBER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />_ WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />_ KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAURDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SEfiVICE — BAH. ETC.1 <br />FOR OFFICE USE ONLY: <br />FRONT SETPACK PEAR Sf:TUACK <br />USE20NE LOIAREA <br />HEIGMT LIMITATION <br />OCCUPANCV NO Oi51 <br />CFOUP <br />FIRE ALARM RE00 <br />FlRF SPRINNI.ER PEO'D <br />7YPE OF f,ONST <br />0 <br />SUBTGiAL $ <br />PERMIT 5 <br />TOTAL FEE $ <br />NO OF D W EI LING <br />UNIiS <br />�s <br />OCCIIPANi LO<D <br />PLANS <br />SIDE SET�ACK <br />ZIP p110NE <br />� ���y yss .�a , <br />ZiP PHONE <br />� .foc�lvlJ��/7�/ %S/Z- <br />LICENSE � <br />LICENSE • <br />HEATING SYSTEM: �l GAS fl ELECTRIC rl <br />CONTACTPERSONANOP ONEN � <br />��,�„a ��n��/ i � U - 9�/�i <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL <br />PROVISIOhS OF LAWS AN� ORDINANCES GUVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GHANTING OF A PERMIT DOES NOT PRESUME TQ GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTIIER STATE (]R LOCAL LAW REGULATING CONSTRUCTION OH THE <br />PEFFJRMANCE OF CONSTRI:^.TION. THAT I AM AUTHORIZED BY THE <br />OWNER Gi� THIS PROPERTY i0 FERFOPM THE WORK FOR WHICH <br />APPLICATION IS MADE AND : COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />� �-Zz -95 <br />X �'" <br />SIGNATU E ^ DATE <br />EJ � � � <br />QTY BUSMEES LICENSE NO. <br />MECHANICAI <br />NO. TVPE OF�EOUIPMENT FEE <br />A/C — A/FiN�LG UNRS — H.P. � <br />FORCEU AIR SYSTEMS — B.T.U. M E.A. � <br />�HEAT PUMP ,T— <br />UNIT HEATERS -- B.T.II. M —� <br />CLOTHES DRYERS � <br />VENI'ILATION FAN � <br />RANGE HOOD � <br />6YATER HEATER <br />WOODSTOVE � <br />METAL FIREPLACE (WOOD BURNING) ; <br />— �— <br />FIREPLACE INSERT (WOOD BURNING) � <br />GAS FIREPLACE ; <br />GASRANGE <br />_ GAS PIPINC ; <br />�... . . . _ . y , . . � <br />SUB TOTAL � $ <br />PERMIT $ <br />TOTAL FEE S <br />PI�NCNECNNUM�ER I FEE � RECEIPTNO. <br />VAGAN7 SITE FEES <br />fIVES fl NO <br />OOII.OING <br />SIZE OF RLUGRI <br />P' UlApMG <br />BASEMENT MGCunNiCAt <br />f7YE5 ('I NO <br />ADp1II04AL PLAN GIF.CK <br />Ot11ER <br />ST�TE OURDMG SURf.NMGE <br />GTY OF EVERETT runi.ic woras <br />LOCAL SALES --- <br />TAX CODE IS 3105 70TAL <br />