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dPPLICATI(._l FOR CONSTRUC7 .JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL [] PLUMBING �SIGN <br /> PROJECTADDRESS: ��� �Uprc�Y�2Qr k'�tu �.11�r,P <br /> ��1,�tuti�-�^���z�J OZ`5t n,� -�yo v vd� S <br /> �/ s -o.�a�/ <br /> OWNEH M�ILA E55 Cltt 21P PNONE <br /> ,�c� t�nue� F�c y�1�3 E�:emreen ��� � � uere-ll- q�ao� ao�,-s�s-�aaa _ <br /> TEN�NT MRILMORE55 GITY 21P PIIONE <br /> \• 1 <br /> C7�Y�Q �CS �{'�nUC'. �1 <br /> ARCHITECTORUES�GNER MAILAOORESS CITY 71P PHONE <br /> St�(plMMALCONTR�CT041 MAILAODRE55 CITY IIP PIIONE d� SUT.•:LICENSE• <br /> � N�����r.a S��r� c'o 55i�,`�t�'�,enw C�,,N � I�'&335 �SI- �4y� l���A�c:oq,3m(� <br /> MECHANiCALCONTRACTOR M ILADDRE55 CI7Y 21P PIIONE STATELILENSE/ <br /> _. I4 / <br /> l7 � <br /> PLUMBINGC NTR�CTOR MRILADORE�S CITY ZIP PHONE S7ATELICENSE/ <br /> CONiMCT PR �pF VIpPK - <br /> ?� c .� �`� HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> DESCPIB WOR;�ND SOU�RE FOO�CE�NV`,LrV\EQ` �,r ,C _ C TACT PERSO �N�O`PHQNE NO� _ � \f��`1� <br /> � 1'K.11 YJ� <br /> _, � <br /> I HEREBY CERTIFY THAT I HAVE RE.A� AND EKAMINED THIS <br /> rnorOs o SE OF BUIIDINa APPLICATION AND KNOW THE SAME TO BC. TRUE AND CORRECT ALL <br /> PROVI310NS OF LAWS AND ORDINANCES GUVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�LDESCNIPTI(k70FPROPER7Y�5HOWNBELOWORATfACHTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ��"` �3 AUTHORITY TO VIOLATE OR CANCEL THE PROV4510N OF ANY <br /> LOT BLOCR OF. <br /> hK�M.va.{ I.O�ng Ol HcR STATE OR LOCAL lAW REGULATING CONSTP,UCTION OR THE <br /> Cn��� �- �� t 3— PERFORMANCE OF CONSTRUCTION.THAT I A�i AUTHORI2ED BV THE <br /> OWNER OF THIS PROPERTY TO PERFOAM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> FMCEL TAX 1.�.NUMBEH CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTiONIO�NLENDER.IIUDRESS.TEIEPNONENIIMBER � G�Izj � <br /> SIGNAT 7E �+T� <br /> GTY BUSINE55 LICENSE NO. <br /> - PLUMBING MECHANICAL <br /> � NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> � - WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS ' <br /> BATHTUB ; FORCED AIR SYSTEMS ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNIT HEATERS ' <br /> KITCHEN SINK$DISP i CLO7HES DRYERS i <br /> DISHWASHER � RANGEI;OOD � <br /> LAUNDRY TRAY ; WATER HEATER ; <br /> CLOTHES YlASHER � WOOD STOVE � <br /> UHINAL ' MEfAL FIREPLACE(WOOD BURNING) ; <br /> DRINKING FOUNTAIN i FIREPLACE INSEflT(WOOD BUFiNING) i _ <br /> FLOOR DRAIN � GAS FIREPIACE ' <br /> BACKFLOW PREVENTERS ; GASRANGF � � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> � EXHAUSTFAN ' <br /> � ' <br /> i ' <br /> i � <br /> � ' <br /> SUB TOTAL S ; SUB TOTAL 3 ; <br /> PERMIT S � PERMIT S � <br /> TOTALFEE S TOTALFEE 3 ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACN REAq SETBIICK SIDE SETB�CN PUN CIIECN NOMBER PEF RECEIPT NO <br /> s�3� c� ��, �v <br /> usezave /1 LOTAREA VAC�NTSITF FEES VALUATION FEE <br /> r3 -v � <br /> ❑YES ❑ NO OUIL��NC �f �J �L � �� <br /> HEIGMT LIMITATION NO OF OWEILING SIZE OF BLDGR.I � <br /> UNI�S PIUTA�ING � <br /> � <br /> OCW�ANCY NO Of510NE5 OCCUPANTIO�D BASEMENT � <br /> GROUP MECMnNICr1l � <br /> � <br /> ❑YES ❑ NO � <br /> ADDIIIONpL PLAN CH(:CN � <br /> FIPESPHINKLEFREO'0 REASON � _ <br /> � <br /> OIHEq <br /> FIREALAF7MRE0'0 AEACON � <br /> STF7EOUILOWCSURLMAfiGE � js� <br /> TYPEOFf,ONST �LANSPPPPOVEDBY CITYOFEVERETT rumicwonKs '� <br /> •�NI LOCALSALES — —'l� <br /> oqTE �I TAX CODE IS 3705 ro7n� p,) � -rL.� <br />