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� APPLICATIOW FOR CONSTRUCTI�ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br />� 3200 CEDAR STREET•EVERET'P,WA 88201 •259-8810 <br />' ❑ DEMOLITION �(�COMBINATION ❑ BUILDII�JO ❑ MECHANICAI ❑ PLUMBINO ❑ SION <br /> � _� � 1, ( 9 <br /> PROJECT ADDRESS: ��J � �f�{i:�F.,2-�1-T <br />'� �orzse-"t�-.1 coti15Tf2U�.Tio.-I i�-�c_ i?�- �.�'�T'� r�v� M/>fz-`f�vl ��E �1�d2'7� <br /> O1M1ER M41�D011E55 qTV =IP PMONl. <br />� <br /> lENY1T 1W1�00NE55 �RY =IV PI�ONE <br />' rod� r�flczs��-i--► �.H� �� - io 34� <br />� MGIIRECTOqOESN'illfR MYI�DDRESS CIlV` ZtP � PNONE IO�(yJi/�. <br /> �a 2SET1--� ��o�.-IST���t(br-� I�--�Ci 54�1.� 1�i�2SC'L�d77 M IL <br /> GENEMLCONTMCTOR 1.W1�0011E55 CiiY =M P�IONE S��TEIICF�NSF� . �7�I) �!� <br />� �� G �54711�L� L�E�EtT� Vh/A �i4?��1�1 ��NL=A�aSS�R l <br /> 4ECNJ1NIGlCONTM!Tqi M/JlA00RE45 CITY tli PNONE ST�TEIICEIMEI <br /> �.r'r� �LU1��3if,.� C� SI�G+-IoMlS�-I �YNA 'SG�P�4237 sioz�T11Z-� k�h <br /> Pl CONTMGTqi MAll�0D11E55 CItY jIp PHONE STATEl10ENSEI <br /> �� Of�'� <br /> COA(MtT vR10E Oi YqRlc . <br /> 5 hf W G�,,1St* HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> OESCIME M/OIYf�MD SOIMIIE F001N3E MVOLVED CONTACT VERSON A4D V/1pNE ND <br /> roCD 3aizs�Tl� 3 lv 4 <br /> I HEREBV CERTiFY THAT I HAVE READ AND-EXAMINED THIS <br /> �o�a� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF UWS AND ORDINANCES GOVERNW6 THIS TYPE OF <br /> WORK WILL 8E COMPLIED WITH WHETHER SPEGFIED HEREIN OR <br /> �cc�oewwrar+ocvravemr�s��ovmee�owan•n.c�iwocovies� NpT. THE pRAN71NG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �m l J �p� � T�a�F'LE>Y AUTHORITY TO VIOLATE OR CANCEL THE PqOVIB10N OF ANY <br /> OTHER STATE OR IOCAL LAW REOULATIN(i CONSTRUCTION OR THE <br /> 01'-' C'P�Z��.51 O F C�A S T PERFORMANCE OF CUNSiaUCTION.THAT I AM AUTMOqIZEO BV THE <br /> OWN OP THIS PROPER7V TO PERFORM THE WORK FOR WHICH <br /> S��L4 — �OCJ —O I f� — D O — APP C ION I ADE AND I COMPLV WITH THE STATE <br /> VMGEI TNt AD.14XlER CO T S 27 RCW AND 288200 WAC. <br /> LONS7RlIGiIONlON1 LFIIOER.�OORE55.TELEP110NE MIMBER x <br /> E <br /> qTY 8U&NE88 LICENSC NO <br /> �� MECHANICAL <br /> NO. TYVE OF FlXTURE Oi11TEY FEE NO. TYPE OF EGUIPMEIR FEE <br /> WATER CIOSET(TOILEn � A/C-M7NDLG UNffS � <br /> �T�� ' 1 FORCEDAIRSYSTEMS � <br /> LAVATOqY(WASH BASIN) � HEAT PIiMP � <br /> SFIOWER � UNITHEATERS � <br /> KRCHEN SINK 8 DISP i 1 . CLOTHES ORVERS i <br /> DISHWASHER RANGE HOOD � <br /> - UUNDRY TMV � WATER HEATER ' <br /> CIOTHES WASHER � .r WOOD STOVE �— <br /> - URINAL � MEfAL FIREPLACE(WOOD BURNING) <br /> - DRINKING FOUNTAIN r flREPLACE INSERT(WOOD BURNINCi) � <br /> - FLOOH ORAIN fiA3 flREPLACE � <br /> �- BACKROW PREVENTERS ; (iA3 RANGE ; <br /> SINK(SEiiVICE-BM,ETC.) Gq$PIPING <br /> � IXHAUST FAN <br /> � <br /> 1 � <br /> � SUB TOTAL f ; SUB TOTAL S ' <br /> PERMIT S � PERMIT S � <br /> TOTALFEE f � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FIION1SEiB�CK REAqSETBACK S�OE":TB�LN OINJCNECNNUMBEP FEF RECEWTNO <br /> Zo 2o S .S Jj � � ; — <br /> use zwE ior�nL� ��7� v�c�at s�r FEE VALUATION FEE <br /> � I JZ7' ES ❑NO BUIIOMf. � / i/� <br /> 11EIGIIT UMTATION NO.pf DWELLING SIZE OF Blo�RJ � <br /> 2b ' ur+rts f /l76 5•P. CNinL4 t PLUMBING � ; I <br /> o S,f. G A <br /> �W�Y MOOfSIpN(5 pLC11p�NiLO�D BASEMENT � <br /> I MECN�NIGQ <br /> �U� ❑YES NO � <br /> � <br /> FIRESPRINKLEqREp'D NEASON �OpilplALPUNCHF.CK <br /> � <br /> OiHER <br /> FIRE9WIRMREO'0 ME�Sp1 ' <br /> ST�iE BUIl01NC SURCH�RCJ — �!�i /) ' <br /> i��i <br /> n�orr,ons* vinr�sevvaoe'1oer CITVOFEVERETT PUBIIf.WORKS �/}� �'� <br /> �N LOCAL SALES `�`�y— <br /> — o�TE � /S �f(� TAX CODE IS 3105 TOTAL � 1�,�.' <br />