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ppplLl�pT1(� 1 FOR CONSTRUC7��N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITiaN ❑ CO/M�BIaNA�TI y �BUILD�NG ❑ MECHANICAL ❑ PLUMBING O SIGN <br /> PROJEC7 ADDRESS: �7I7 �'�`�/�� UJ� <br /> M.GN.A rn �o -�aB��I.�. a�t.�v� �,.+A4�sr�_�2o6��-so- z�o� <br /> pyyryEp MMLADDRE55 LIN :I:� PHONE <br /> MA�� c��c� �rc (�/o �-�a�a.a� ��,nr�� oK��G2 �q19 �� ��°3 <br /> iENIWT T M L/�U�RESS GI Y ZIV FMONE <br /> ARCHITECTO•RDESIGNER MAIL/�DORE55 GITY ZIP �NONE <br /> VJDOI�If�'CT-� C��Y7TP yT� '{l./� $E�`�i� PR �201 �.�1lJE 9$�SC2o6)�5$�Z1 wx�OMcLl6`io� <br /> GENEMLCONTfiACTOR MAIIAD�RE55 G17Y Z�r PIIONE Sf�TELiCENSE• <br /> M H/�NICALCONTR�CTOR MAIIAWRE55 C17Y ZIP PNONE STATEUCENSE� � <br /> P,/MBI11G CONTR�CTOR MAIL/�DORE55 ��n' I�P PNONE STATE LICENSE� <br /> S a-�� <br /> cor+rw�crP GEOF WOPN HEATING SYSTEM: AS ❑ ELECTRIC ❑ <br /> OESGRIBE WORK I1ND SOU�RE FOOiAGE INVOLVED CONTRCT PEHSON ANL PHONE NO <br /> + �D Z"�Q.� � <br /> ci� - <br /> F Ztx� S 3�:�- <br /> " � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> v��� se oF euunu � PROVISIONS OF I.AWS AND ORDINAN�ES GOVERNING THIS TYPE OF <br /> ���. ,�yN,_. WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALOESCRIPTIONOFPR PEF7NI�OWNBELOW ��nACHTWOCGP�ES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF AN'! <br /> OTHER STATE OR I.00AL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOF WHICH <br /> LG� �� ,,.o�� 1 � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> �_ Y �'1]� CONTRACT S LAW 1 7 RCW A 96200 WAC. <br /> p "��I.O.NUMBER � <br /> A1 3-i�- � <br /> Gpq IICTiON IONI LENDER.AOD1iF55.TELEPMOME NVMBER x pATE <br /> NATURE <br /> CITY BUSINESS IICENSF.NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—AIHNDLG UNfTS � <br /> BATHTUB ; FORCED AIR SYSTEMS � <br /> LAVATORY(WASH BASIN) � HEAT PUMP ' <br /> � UNIT HEATERS � <br /> SHOWER � <br /> KITCHEN SINK 8 OISP i CLOl HES DRYERS ' <br /> � <br /> DISHWASHER � RANGE HOOD ; <br /> LAUNDRY TRAY ' WATER HEATER <br /> � <br /> CLOTHES WASHER ' <br /> WOOD STOVE ' <br /> � ME�ALFIREPLACE(WOODBURNING) ' <br /> URINAL ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT(WOOD BURNING) � <br /> � <br /> FLOOR DRAIN � <br /> GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GAS RANGE ' <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> � EXHAUSTFAN � <br /> � <br /> � --+-- <br /> � <br /> � <br /> i <br /> � <br /> � <br /> � <br /> � <br /> , SUB TOTAL S � <br /> SUB TOTAL S � <br /> PERMIT $ PERI.FIT S � <br /> � <br /> TOTALFEE S ' TOTALfEE E ' <br /> FOR OFFICE USE ONLY: -- - <br /> AEf.f.IPT NO <br /> FRONT SETB�LN AEFR SFTBRCK SIOE SEiBACK PUN CIIECK NUM9ER T i f EF��� �� <br /> S//�?.� <br /> FEES VALUATION FEE <br /> USE 20NE LOT AREA VAC�NT SITE C �� <br /> ❑YES ❑ Nn OUILDINF ��J QDO D � � <br /> HEIGNTLIMITATION NOOFOWEtLING 512EOfBLDGRI ' <br /> UNIi$ n�q PlpM01NG T <br /> L � <br /> OCCUPANCY NO Oi$IOHIE$ OCCUP�NilO�� BASEMENT MEGN4NICnl ' - <br /> PPOUP / � - � <br /> A� ❑YES NO � <br /> /� Ap01110NRL PUN C��F.CN <br /> FIAESPfi KLEfiPEO'D REASQrY ,/ (� // � <br /> �S `-^Jr�''• Ol11E17 <br /> FIFEALARMREO'D RFASON ;G:/'1 <br /> �`S ��(Sr(, srnieoonowcsunc��nnre _ y,L(L <br /> Trreovr.or+st PinNs�rr veoav CITYOFEVERETT P119Uf.WAPNS �_ <br /> ✓y � /� LOCAL SALES ��; <br /> onrE .j 0—S(, TAX CODE IS 3105 70TA1 <br />