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APPLICATI�'i FOR CONST�iUC'i"JN PERMIT�,�}� <br /> CITY OF EVERETT•BUILDING DIVISlON �-r�7��,'��o . I�� <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 'C�J— <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILnDIN'G ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: �ZDZ CO��j�� /�T�/�. <br /> Itiim SaL�n+4 �32i(� i�lor r� L=�/�tr.,�x1" � �i�'2,�1 �f,�����I-S/�/ <br /> ONTlER M�I�AOORE55 Cltt 21P PIIONC <br /> ,..�,,� n�o�e,��is 3zo2 �/bv �=ue�-.e� r�✓-1 ��2d/ �a S_ <br /> TCNIINT^ MIJI./�pDRE55 CI7Y ZIP PIIONE <br /> /V '� <br /> AqG�T�CTOR�S�GNE�L���D/RE'55 Cltt 21P PNpNE <br /> ��G C�J L NSr�uc�7onl .l�a . �535 Ah��������_��a��.P.-s�G LTi�� is�K� <br /> GENEMICOAHiP�CiOR MULA0DRE55 LitY 11P PuOYE SIAfELICENSE� <br /> �/!'! <br /> MECN�NI ALCONTRACTDiI M/Jll1DDRE55 f.ITV IIP PNONE SiATELILENSE� <br /> P�pMBIN%�TN�CTOIi MAILADDRE55 GIfY 71v PNONE STAfELICENSE� <br /> CONtNACT P E OF VIOIIK <br /> ���v NEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> . <br /> DESGRIBE N�ND SW�pE FOOT/�GE INVOlVEO CONT�LT f'C�SONAND PNONE NO <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPIICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT ALL <br /> PRq'OSEDUSE OF Bl11LDING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETNER SPECIFIEO HEREIN OR <br /> IEG�IOFSCF1PT10NOFPqOPERTY�SHOWNBELOWq7ATTACNTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or eiocK oF AUTHURITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCT�ON Ofi THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OVlNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WIiH THE STATE <br /> PMCEL T/JI I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 2 00 WAC. <br /> CONSTPUCTION IOAN'ENDER./�ODRESS.TELE�110NE NUMBER � � � ^'V ���—/�� <br /> SIGN U E D�IE <br /> CITY SINESSLICENSENO <br /> PLUMBING MECHANICAL <br /> HO. TYPE OF FI)CTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—NFINDLG UNITS ' <br /> BATHTUB ; FORCED AIR SYSTEMS � <br /> LAVATORY(WASH BASIN) � HEAT PUMP ' <br /> SHOWER ' UNITHEATERS <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS � <br /> DISHWASHER flANG[HOOD ' <br /> LAUN�flY TFAY � WATER H[AT[R ,�_ <br /> CLOTHES WASHER � WOODSTOVE ' <br /> URINAL ' ME7'AL FIf1EPlACG(WOOD BURNING) ; <br /> DRINKING FOUNTAIN � FIREPLACE INSERT(WOOD OURNING) � <br /> FLOOR DRAW GAS FIREPIl+CE ' <br /> i <br /> BACKFLOW PREVENTERS ; GASRANGE <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING <br /> � C-XIIAUST fAN _ <br /> i <br /> i — <br /> � <br /> i <br /> i <br /> SUB TOTAL S � _ SUB TOTA� E � <br /> PERMIT 5 � PERMIT E <br /> TOTALFEE E ' TOTALF[E E ' <br /> FOR �FFICE USE ONLY: <br /> iPONi5ET0AC% RE�NSET�A�N SIDESEiB�CN �UN�IIECHNUTApP fEF RECEIPiNO <br /> �� � � <br /> vs6¢or+E IOTAREA WCANf511E FEE VALUATION PEE <br /> ❑YES ❑NO � <br /> OUIl01NG <br /> NEIGIR L�MITATION NO OP OwEILING 54E OF OLDGRI ///��� ~— <br /> UNII$ ^/ /� � P�')MOING —_ � <br /> C�(f l� T <br /> OCCUPANCY NO(%51[NUE$ O;CVP�Nf 10�0 9ASfMEN kECNAMG�I i _ <br /> GPWP q i <br /> J YES ❑NO <br /> FIRESPPINKLEHBEO'0 �E�SON �UDIi.ON�I�L�NC��fGK -- � <br /> ---T-- <br /> �v� OLIEn � I <br /> FIREAIARMREO'D AH50N � <br /> Ny� $TA1E OUIIO�NG SURCH�R6E —_ '_ <br /> trreorr.or+st rtnHSe v[oor CITYOFEVERETT runnr.wnnr.s 1 _ <br /> / LOCAL SALES '—"----- � <br /> V` � o.re l� �11 '�i � TAX CODE IS 3105 TOTAL _ <br />