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APPLICATIO. . FOR CONSTRUCTL�.N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> . 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOUTION ❑ COMBINATION �BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: �(f, % C� �}���pr�7 U/,ra <br /> �MMER MML��ORE55 GTY 21P PHON[ <br /> JPis e 11�n25 . / , r �� />�/'na,li �1�y � � r� �1 � �f � (/� <br /> TE�T Mul�0IX1E55 <br /> C'!Y IIV PnONE <br /> �RGMTECT dl fiESIGNER MIUL�DORE55 ) ��ry � <br /> 1r�" t7 7�-�S� /j7 �-hUi=4'f � J.�t/..r�wc.s� r�� <br /> 9d'.z S� c %7s�,� p—,�' �Gli � <br /> GENER/4GONTR�piOR uNLnODRC55 �ITY z�p PnONE SIATEIICENSB� <br /> MEp7IwICNCONTR�CTOR MAII�DDRE55 qiY ZIP PHONE � G� ',57A�GCNSE J � �J)�—� <br /> RU1,Bp1G CONTRACTOR MAILADDRES$ - ��n �I� I �J '� .� 7,»Tl <br /> ��TM T�P P�'E STATE lIC[NSE� <br /> CONTR�ILTPM[EOFWORK � <br /> � , � k�� r'r r? L HEATING SYSTEM: ❑GAS ❑ ELEC7RIC ❑ <br /> DESCHIt7E MORK ANU SqJARE FOOT�E INVOlVEO LOHTACT PERSON AND VNpNE NO <br /> --�(_._Y_l�-v� •• •� S � <br /> I HEREBV CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> vnor� o usE oF dmdrq/ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALl <br /> �'�si ��f M'- � '7 �- /�O Fu tK '/`Gr !J L PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �c�°Eum°�ro�amopEpTv�s�awNBE�owaa�n�cNnwcaoies� �'�'ORK WILL BE COMPLIED WITH WHETHEti SPECIFIED HEREIN OR <br /> ior Z L y �� �+� THE ORANTIN•3 OF A PERMIT DOES NOT PRESUME TO GIVE <br /> e�ocK oF ` � •�'i " AUTHc;,'.ITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> ' OTHER STi TE OR LOCAL LAW qEGULATINO CONSTRUCTION OR THE <br /> �� PERFORMANCE OF CONSTHUCTION.THAT I AM AUTHORI2ED 8Y THE <br /> / ' OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WMICH <br /> ( L✓� � APPLICATIJN IS MADE AND I COMPLV WITH THE STATE <br /> ru��i�x i.o.ru ieen ' CANTRAC'CORS LAW 1 27 RCW AN 296.200 WAC. <br /> CONSTRULTIONIOANIENDER.A00lIESS.iELEPIqNENIMDEP X y �JO'� <br /> 51GN� O�TE <br /> CI AU5INESSLICENSENO. <br /> P�V��� MECHANICAL <br /> NO• TYPE OF flXTURE OR 1}EM FEE NO. TYPE OF EWIPMENT FEE <br /> WATER CLOSET(TOILEn � NC—NHNDIO UNR'S � <br /> BATHTUB ; FORCEDAIRSYSTEMS � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> � <br /> S��R ' UNIT HEATERS � <br /> KITCHEN SINK 6 DISP i CLOTHES DRYERS ' <br /> � <br /> DISHWASHER � RANGE HOOD , <br /> • LAUNDRY TRAV ; WATER HEATER � <br /> CLOTh'ES WASHER � WOOD STOVE , — <br /> URINAL � MEfAL FIREPLACE(VJOOD BURNING) � <br /> DRINKIN6 FOUNTAIN ; FIREPIACE INSERT(WOOD BURNIN6) ' <br /> i <br /> ROOR DHAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS � GASRANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING , <br /> IXHAUST FAN <br /> i <br /> � � <br /> i � <br /> � <br /> � � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S ; <br /> PERMIT f � PERMIT S � <br /> TOTAL FEE S � TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACR RE�R$ETBI�CK SIDE SETB�CR P�AN CIIECN NUMBCR fEF 17ECE�PT NO <br /> USE ZONE lOT�REA yA��Nf SI1E FEES VALUATION FEE <br /> ❑YES ❑NO �-- <br /> — OUIL�INC � /�� � <br /> NE�GHT LIMIT�TION NO OF OWELIJNO 512E OF BIDGRI �� <br /> bN115 P�p1,101NG � � <br /> i <br /> OCCUP�NCY Iq OfS�(MEES OCCVPANTIO�D B�SEMENT � <br /> GtiWP IAECIInNiLnL <br /> �YES ❑NO � <br /> i <br /> FIRESPIiINKLEqflEO'D REASON �O�IIION�LI4ANG�CCN � <br /> 0711ER � <br /> FIREMAIiMREO'D RE�SON � <br /> i <br /> Si�TE BURDiN6 SunGMAOGE �/i <br /> C/ <br /> TYPEOFf,pNST P�ANSAPPPOVEOBY CITYOFEVERETT �IIBIif,WORKc � <br /> LOCAL SALES —.1_ <br /> D�TE TAX CODE IS 3105 TOTAL ; <br />