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APPLICATIGA FOR CONSTRUCI .JN PERMIT <br /> CITY OF EVERETT• BUIIDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> f� DEMOLITION fl CQMBINATION y� BUILDING f� MECHANICAL I� PLUMBING f� SIGN <br /> PROJECT ADDRESS� Q� '7 _ D r�C � I�� C � <br /> � ! \ V't <br /> OWNER MRRADDRE55 /fLltt ZIP �, FHONE <br /> �o���� � �0�� -1 ,%� � ';�,Y- _ /"�f �',. � � ��;' 'i <br /> TENRNT MA�LADDRE55 CITV Z�P PNONE <br /> ��`�-1 � `� �2E�A�\`� � \ <br /> C �JT�ORDE��G.Lp�oCJ ��LATD^E1 5 �U y�� l�` 'NC�IO� W �WV\F�W � PNON�G U ��.�� I <br /> �V ` <br /> � GENERAL CON1RnCTOR MAILAODRLSS Cliv ZIP PHONE STATE UCENSE� �y � �L <br /> ,�av-���1WrECSce,�T , ��3� �� t9�tC�cS�,�N��cv�ly�'j'-�f��;(� 7a3�36 ($ � � a-oi ��oN� D� _ <br /> MELMANILRLCONTPACiOR MAILADDRESS CITY 21P PMONE STATEUCENSE� <br /> �i � , i <br /> ` J <br /> PLUMBINGCONTRRCTOP MAILADDqESS Cltt 21P PHONE STATELICENSE� <br /> CONTRACTPqICEOF WORK I I�7, �Ql�. , �' ' <br /> ( � � HEATING S1'STeM: Cl GAS ❑ELECTRIC ❑ <br /> �SI�C`JON�yDSOUAP � l\�N�V� �� O �f�(C�� GONT�C 1\�X1�N,��ONE-O. � _��^ � ^ �U <br /> a `� N �� <br /> I HEREBV CEflTIFY THAT I HAVE READ AND E7(A'AINED THIS <br /> PROPOSE VSE OF gw�ovao APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � � µ� � (� � �q `` �I� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � t �t " C I WORK WILL BE COMPLIED �vITH WHETHER SPECIFIED HEREIN OR <br /> LEGALD SCRIPTIONOFPRpPF1:fYI5HOWNBELOWORRTTACHTWUGOPIES) NOT. THE GAANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or n�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER O�' '+iIS PPOPERTY TO PERFORM THE WORK FOR WHICH <br /> AP UCA' -r� IS MADE AND I COMPLV WITH THE STATE <br /> rARCEL TA%I D.NUMBER C�NTF�A�G wFS LAW 1B.Q{�7 RCW AN 296200 WAC. <br /> CANSTRUCTION LORN LENOEit.A�pRE55,TELEPHONF.NUMBER x/�1�',�C`'� \��� I ��✓�( �� � <br /> SIGNRiUHE ORTE <br /> QTY P.U9NESS t ICENSG NO. <br /> PLUMBING MECiIANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FI%TURE OR ITEM FEE <br /> WAl'ER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB � FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) HEAT PUMP i <br /> SHOWER � UNITHEATERS—B.T.�I. M <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS i <br /> '— _�_ <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRYTRAV ; RANGEHOOD � <br /> CLOTHES VyASHER � WATER HEATER —�- <br /> URINAL WOOD Sl"OVE ' <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAW � FIREPLACE INSEFiT(WOOD BURNING) � <br /> BACKFLOW PREVENT[RS � iA5 FIREPLACF ; <br /> SINK(SERVICE—BAR, ETC.) � GAS RANGE <br /> � GAS PIPING � _ <br /> i EXHAUSTFAN i <br /> � � <br /> i � <br /> _ i i <br /> � i <br /> SUB TOTAL $ � SUB TOTAL $ � <br /> PEFMIT $ i PF.RMIT $ i <br /> TOTALFEE $ � TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> flIONT SEIAACK R[AF SFTPACK SIDE SETBACK PLAN CHf.CN UMBER ff.[ � RFCEIPT NJ. <br /> {nt�,-�C� � . , .':1 �(; �r"% <br /> use zone iot nnEn VRCANI SIT[ FEES VALUATION FEE <br /> flYES fl NO BNLDIN� I � ��'. -I <br /> i _�___ _ <br /> H[IGHT LIMITATION NO.O�DWELLING 512E Of BLOG�I <br /> 11Nii5 A2,a� T/ PWMBING � <br /> "T'T! / <br /> � GROUPANCY NO Of Si0PiE5 OCCUPFNT LpqD BRSEMENt M[CHANICAL � <br /> i <br /> �z � zri. 29 ���ES ,��o , <br /> ADDITIONRI PLAN CHECN � <br /> FIRE ALAFM fiW'0 REASON � <br /> �i�; �xi��nrc�CT GTHER � <br /> FIRE SPRINHI f:P REOD FEASON <br /> yC(.� r�7{�f��n�;� SiATE BUILDING SURCMARGE � � � � <br /> V hl <br /> irreorcoNsr PUNSAPPoveoer C�TYOFEVERETT runucwoaKs ' <br /> �J J� LOCAL SALES � <br /> oaiE �� � TAX CODE IS 3105 TOTAL I <br />