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� � <br /> APPLICATI�.N FOR CONSTRUCI iON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEIYIOUTION ❑ CON181NATION ❑ BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: a 7 � <br /> 111aeQ — ' � U�- Z � <br /> OWNER MIUL�UpiE55 Cltt Zip pHp�E <br /> TENNlT Y/Ul Wpq[55 GITY 21P pipHE <br /> 11RGINTEGTp10E51GNER MMI�DDRE55 pTY 71P PHONE <br /> GENERKCONTMpOR M�IIADURE55 GIIV pIP PIIONE $I�fEl1CCNSE� <br /> � u�n�r il�t�i - �m7h�rnrl��� t�l, l���99 282-47��n nl�2trau��a �<���a <br /> MEdUNiCAL CONTR�CTOR MIJUDDRE55 CI ZiP PHONE SThTE LILENSE� �— <br /> MUAlmCCONfR�CTOR MMLIIDORE55 qfY =IP p11pNE ST�TELICENSE� <br /> caHiiuct v�ov wonrt <br /> HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> OESGRIlE WORK�NO SOU�qE FOOT/�E MVOlVEO ONTIICT PCRSOII�Np PNONE NO � . ^� <br /> �� <br /> ������' <br />� ��`'' �o�� I FIEREBY CERTIFY THAT I HAVE FEAD AND EIfAMINED THIS <br /> �j�'� wqr`OseD u5E OF aui�onxi APPLICATION AND KNOW tHE SAME TO BE TRUE AND CORRECT ALL <br /> •� n PROVISIONS OF LAWS AND OROINANCES GOVERNING THIS TVPE OF <br /> � FK' W O R K W I L L B E C O M P L I E D W I T H WHE THER SPECIFIED HEREIN OH <br /> LEMl0E5Ci1IPM1NOFPqOVERTy�51qYVNpE�p✓/pq�T7�1CM7WptOPIES) NpT. THE ORANTING OF A PERMIT DOES NOi PRESUME TO GIVE <br /> iot_ e�oc�� or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STAtE OR LOCAL LAW RECUUTIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTMORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM T}iE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> �L TN(I.D.M/GBER CONTR�CTORS lAW 18.27 RCW AND'[96200 WAC. <br /> �3 - �,�3 -n i n-nr��-� - ' 1� r <br /> Cp15TRUCTHX/IOiW IENDER.�ODRE55.iElEP1qNE NUMBER x�l ��2q Il�/1�. �I�.3/,91r�_ <br /> SM.NI1fURE D�iE <br /> CITY BUSINESS LIGENSC NO <br /> PLUM81N6 MECMANICAI <br /> NO. TYPE OF FlIRURE OR ITE1A FEE NO. T'PE OF EOUIPMENT fEE <br /> WATER CLOSET(TOILET) � NC—AMNDLG UNfTS � <br /> j� � i BATHTUB � FORtiED AIR SYSTEMS ' <br /> � <br /> ��, � UVATORV(WASH BASIN) � HEAT FUMP � <br /> � . ' '� , SHOWER � UNIT HEATEHS � <br /> '_x KITCHEN SINK 8 DISP i CLOTHES DRVERS ; <br /> �~� .a. • DISHWASHER � RANGE HOOD � <br /> UUNDRY TRAV � WATER NEATER ' <br /> i <br /> '�� � � � CIOTHES WASHER � WOODSTOVE � <br /> , URINAL � METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT(WOOD BURNING) ; <br /> ROOR DRAIN � GAS FIREPLACE � <br /> � � BACKFLOW PREVENTERS � GASRANGE ' <br /> � <br /> SINK(SERVICE—BAR,ETC.) � � ' GAS PIPING � <br /> ' EXHAUSTFAN <br /> � � <br /> � <br /> � i <br /> � � <br /> � <br /> � � <br /> SUB TOTAL f � SUB TOTAL S � <br /> PERMIT S � PERMIT S � <br /> TOTALFEE E � TOTALFEE f ' <br /> FOR OFFICE USE ONLY: <br /> iRONi SETBALN PE�R SETBACK SIDE SETB�CN PL�N CHECB NUM q fEF REf.E�PT NO <br /> J c��� .�— <br /> usezOnE iot�nee V�CANI517E FEES VAlUAT10N FEE <br /> ❑YES ❑NO OUIIDINCr i <br /> NE�GNTtIMITA710N HOOFUWEUlNO SIIEOFeLDGRI <br /> UNIfS <br /> PLP IqING <br /> OCC�UP�NCV NO Of SIMtlFS OCNP�NT 10�0 BISEMENT MEC1uNICQ 4 <br /> ❑YES ❑NO <br /> FIRESPRINKIEPREO'0 AE�SON �DUI110N�LPLANC11f.CR � <br /> -�- <br /> oiHcn ' <br /> FIflEA1MMRE0'0 RE�SON � <br /> ST�IE BUqpINC SIIRCIURfE � <br /> __ �� <br /> TYPEOFf,ONST PLANS��'PROVEOBY CITYOFEVERETT �1191if.W�(1N5 <br /> LOCAL SALES - — —�— <br /> D�TE TAX CODE IS 3105 TOTAL I <br />