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APPLICATIO.� FOR CONSTRUCT+JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING 0 MECHANICAL �PLUMBIHG ❑ SIGN <br /> PROJECT ADDRESS: ,.14.Z S' C•�4 �.a �r.��� <br /> OWNER MNL�Dd1E55 n q1Y 21P PHONC • <br /> C/�,/..Q.�� r`'�t rl'l.i��, f C� �J 1c SZG 7 l�G 2.c:�v25 S- `i 3�- 'i — <br /> TENAN� MAICAUDRE55 GiY liP P110Nf <br /> , T LTOi1D IGNER MNlA00NE55 CITY fIP PNONE <br /> GEMERK COMffUCiOf1 <br /> MNIMDPE55 GfY ]�f PIIONE 51111EIIC[NSE• <br /> MfCHMnLAICONTR�CTOR MAIIADDRE55 CAtt 2�P �IIONE STAiEULENSE• <br /> PLVMB�NGCONiRACTOR N�ILAW��ESS CIfY 21P PIIONE ST�TEIICENSE� <br /> / .� - � J Z n i S�,Zi S6b-` z37 �� Sn//��v <br /> Cd/T1ULiPPoGEOF W011N � HEATING SYSTEM: ❑GAS ❑ ELECTRIC O <br /> pESCRIDE Y'ORN�NU SOU�AE i00TACECIN,VOIVED CONT�CT PCRSON N10 FNONE NO <br /> — � I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> y1qPp5ED VSE OF BVILDINO PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPt OF <br /> WORK W�LL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEWLOESCPoPTIplOPFROPERNI3��������iTkN�WOCO�ES) NOT. T"E CaRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHOHITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> ioi e�aK �F OTHEfi STATE OR LOCAL LAW REGULATINO CONSTRU�TION OR THE <br /> FERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOHRED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> pAqCEL T1Uf I.D.MMBEP E � <br /> �_ . (� f1 / \ _�� J ��r�l) <br /> �pNSTqUCTIpN LONI LENUEfl,�DURE55.TELEPIIOME NUMBER x�� DATE <br /> 516N�lURE <br />� CITY BUSINE55 LICENSE NO <br /> PLUMSINf1 MECHANICAL <br /> FEE N0. TYPE OF EOUIPMENT FEE <br /> Np, TYPE OF fll(TURE OH ITEM q�C—qh{NDIG UNITS � <br /> WATER CLOSET(TOILEn <br /> BATHTUB ' FOHCED AIR SYSTEMS � <br /> � <br /> � HEAT PUMP ' <br /> UVATORY(WASH BASIN) , UNIT HEATERS � <br /> SHOWER ' <br /> ' CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP ' <br /> DiSHWASHER � HANGEHOOD � <br /> WATER HElQER � <br /> UUNDRY TRAY � , <br /> CIOTHES 1 '.SHER � WOOD STOVE <br /> MEfAL FIREPLACE(WOOD BURNING) ' <br /> URINAL � ' <br /> DRINKING FOUNTAIN ' <br /> FIREPLACE INSERT(WOOD BURNING) � <br /> � GAS FIREPLACE � <br /> FLOOR DRAIN � <br /> � GAS RANGE ' <br /> BACKFLOW PREVENTERS � <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING � <br /> EXHAUSTFAN � <br /> � <br /> � I <br /> i <br /> i <br /> � � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL f � <br /> PERMIT S O � PERMIT S � <br /> TOTAL FEE S ' � TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: ���emr Ho <br /> RENiSET9�LK SIOESETB�CN PlANq1ECNNUMBEO PEF <br /> ippNTSETPALK _ <br /> FEES VAIUATION FEE __ <br /> USE ZONE l OT ARE� V�CANT SIIE � <br /> � <br /> ❑YES ❑ � OtnIDMR ' <br /> � <br /> HEIGMT LIMITATION NO Oi OWELIING SIIE OF BLOGRI � <br /> UNIi$ MUM�IN6 T— <br /> i <br /> OCCUPANCY 1q 0l5�(�ES OCCUP�NTIO�U BASEMENT MECN�Mf.GI � _ � <br /> GRWP ❑YES ❑HO i <br /> �pD1IlONAL1'UNGNF.CN . � <br /> FIRESPRINNIERREOD ��FASON � � <br /> OLrtP � <br /> FlRE�WIFMPEO'D pE���N i I <br /> 5TA1 E BUIlOM6 Sp�CH�11GE <br /> __ � <br /> IYPEOFf,ONST Pl�NSAPPROVEDOY CITYOFEVERETT �IIff11f.W0f1NS _ ___�_ <br /> LOCAL SALES <br /> O�tE <br /> TAX CODE IS�105 TOTAL <br />