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APPLICATIL_J FOR CONSTRUC7 _JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION �C�/�� <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> Q DEMOLiT10N ❑ COMBINATIO/N ❑ /B ILDING p MECHANICAL O PLUMBING ❑ SIGN <br /> PI90JECT ADDRESS��U 7/-�J��'� `��. � � F�LtJr <br /> G <br /> pyyMiR ' L � MIULA00RE55 Gtt 21P PNONE <br /> �t1<,elt7 Ti°.��if9o�oqieS <br /> TENl1\T /�DDPCSS GIIY 71P {'110NE <br /> ARCMTECTOi1DESIGNER MNlA00PE55 LITV Z�P PNONE <br /> GENERNCONTR�LTOQ MNL6WRE55 CIIY IIP PIIONE SGiEIICENSE� <br /> MECHANIC0.CONTRApiOF MI11lADDRE55 CITY LIP PIIONE ST�TEII�ENSE� <br /> PLUAl�NGCONTB�CTOR M�ILAODRE55 Gtt ZIP PIIONE STATEIICENSE� <br /> CON�MCT VR�CE OF NORK <br /> HEATING SYSTEM: C]GAS ❑ELECTRIC � <br /> OESCPoBE NVpN AND SOUARE FOOTAGE INVOLVEO CONT�GT GERSON M!0 PNONE NO <br /> u�+ i <br /> I �iEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> vnoposeo us¢a eun.ou+c PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILI 8E COMPLIED WITH WHETHER SPECIFIED HEFEIN OH <br /> IEGALDESCPIPTIONOFPAOPERN1�roNMBICLOWORRT11CHiWOCONES) NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot e�ocK oF AUTHORITY TO VIOIATE OR CANCEL THE PROVISION Of ANY <br /> OTHER STATE OR LOCAL LAW REGUUITING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PHOPERTY TO PERFORM THE WORK FOH WHI:.H <br /> APPIICATlO IS ADE AN I COMPLY WITH THE STATE <br /> PMLELTA%I.D.NUMBER CONTRAC 1 ,,�J ND 96.200WAC. <br /> CON57iM1CilON LOAN LEN�ER,J1DD{1ESS.iELEP110NE NVMBER x j0�/ ( ___ <br /> SIGN�TIIRE DAIE <br /> qtt BU5INESS IICENS[NO. <br /> PLUM&NO MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EOUIP�IENT FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLG UNR'S � <br /> BATHTUB ; FORCEUAIRSYSTEMS ; <br /> IAVATORY(WASH BASIN) � HEAT PUMP i <br /> SHOWER ' UNITHEATERS ' <br /> KITCHEN SINK 6 DISP i CLOTHES�RYERS � <br /> DISHWASHER � RANCaE HOOD � <br /> UUNDRY TRAY � WATER HEATER ; <br /> CLOTHES WASHER � WOODSTOVE <br /> URINAL ' MEfAL FIREPIACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT(WOOD BURNNG) � <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTEiiS ; GAS RANGE i <br /> SINK SERYICE—B R,ETC.) � GAS PIPING � <br /> � EXHAUSTfAN ' <br /> � <br /> � � <br /> � � <br /> � � <br /> � � <br /> SUBTOTAL S � SUBY7TAL f ; <br /> PERMIT S � PERIAT S � <br /> TOTAL FEE f � TOTAL FEE f ' <br /> FOR OFFICE USE ONLY: <br /> FqONTSEiB�CK Rf�PSETBACN SIDESEiB�CK PUNCIIEGNNOMBER iEF RECEIP:NO <br /> 5a � <br /> USEZONE IOT�REA v�c�nrsre FEES VALUATION FF.E <br /> T <br /> � <br /> ❑YES �NO ONLOINB � <br /> MEIGNT UMItAT10N NO OF DWEIUNG SIZE OF BLDGR.1 � <br /> UNIiS PIUMBING <br /> �.�'�' <br /> OC�P�NCY MO 0�SIMi[5 OCCU�AN7 LO�D B�SEMENT MECIInNILPL � � <br /> OYES ❑NO � <br /> ADDI110N�L f UN CII(.LI( i <br /> FlRESPFINNLERRGO'D REASON �_ <br /> i <br /> on�en ; <br /> FIREAIMMREO'D RE�SOY <br /> 51R7E OWLOWO SUOGIIRRGE � <br /> TVPEOFf,ONST Pl�NSMpROVE�BY GTVOFEVERETT ���OIIf.WORNS <br /> LOCALSALES --�' <br /> on.E TAX CODE IS 3105 TOiAL <br />