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( — <br /> APP�.ICATIf3�. FOR CONSTi�UC7'6,.�t�0 PERMIT <br /> CITY OF EVERETi•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 � <br /> ❑ �FMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS: IY� � - � r o� `IT� � —�C-'Z���N . <br /> ►--,�r�� �r�I r� o � �-� �v�V t--�����-1- <br /> ( H�1E � M IL�OIX1E55 CITY zIP PNpNE <br /> u�r�rr�TPc�-t1.�Ps 2�U"1 oi �y A�1e t��- <br /> TENMlT uML�00RE55 GTY 71P PIIONE <br /> �'Gr��►�.►-r��i _r►�c.. . <br /> ARLHITEGT OR DESIGNER NMl/�DORE55 CIIY��� PNpNE <br /> -�a ►-ner �r-r�ru�fin� � �a��� 34 Fc�-�c� <br /> GENEP/�ICONitiACTM M�IL�WnE55 7iP PIIONE SGTEUCENSE� <br /> �r�r� �1��'N�rvir.�� �� �fi'���e �a,��m �i-y"XIC� �n�nC+�taz <br /> MECHANICqCONiR�CTOR MIUL�DDHE55 C1TV III' PIIONE STATELIGENSE� Cs <br /> PLUMBIhOLONTPA�TOR M�ILIIDDRE55 Gtt 21P PHONE SIATELIGENSE• <br /> LONTMCT PPoGE OF WORN <br /> . HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> OESCRIlE MARK�ND �R FOOT�GE NVOIVED � CONT�CT PERSON M!U P110NE NO <br /> �J� ' X �—l� , �r� ,T � � HCREBY CERTIFI' THAT I HAVE READ AND EXAMINED THIS <br /> vnoaoseo use oF eu��dr�n APPLICATION AND KNOW 7HE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPE OP <br /> WORK WILL BE COMPIIED WITH WHETHER SPECIFIED HEREIN OR <br /> 1EG1110E5LPIPTIONOFP{qPERTY(51qVR/BELOWOq�TT/�CNTWOCOPIES� NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot B�ocK ov AUTFiORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHE:A STATE OR LOCAL LAW REGULATINO CONSTRUCTION OH THE <br /> PEHFORMANCE OF CONSTRUCTION.THAT f AM AUTHORIZED BY THE <br /> '' � ' rl OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> p! APPI.ICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMLELTA%ID.MIMBER CONTFACTORS lAW 1827 RCW AND 296200 WAC. <br /> // ( 4 <br /> CONSTRUCTION LONI LENOER,I1D0{IESS.TElEP110NE NUMBEA x_ G �'�a� `�o <br /> SIGNATUH DATE <br /> CIiY IIIIciNESS UCGNSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNfTS ' <br /> BATHTUB ; FOPCEDAIRSYSTEMS ; <br /> UVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNITHEATERS ; <br /> KITCHEN SINK 6 DISP i CLOTHES DRYERS i <br /> DISHWASHER � RANGEHOOD � <br /> LAUNDRYTRAY ; WATER NEATER � <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL ' MEfAL FIREPLAC[(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERi(WOOD BURNING) � <br /> ROOR DRAIN � GAS FIREPLACF. � <br /> BACKFLOW PREVENTERS ; GASfiANGE �_ <br /> SINK(SERVICE—BAR.ETC.) � GAS PIPING � <br /> � IXHAUST FAN ' <br /> � � <br /> � <br /> � � <br /> — � � <br /> � <br /> � � <br /> SUBTOTAL S � SUB'fOTAL S ; <br /> PERMIT E i PERMIT S �— <br /> TOTALFEE E � TOTALFEE f ' <br /> FOR OFFICE USE ONLY: <br /> iRONTSETBACK REARSETB�CK SIDESETB�CN PUNCIIECNNUWA[R �EF ' �ECflPTNO <br /> -;2 n � o _ <br /> u5E2onE LOT�nEA veCeNrSttF. FEES VALUATION FEE <br /> ❑YES ❑NO OUIIDINC. � <br /> i <br /> HEIGHT LIMIUTIDN NO OF OWELLIN6 512E Of BIOGR.I � <br /> UNII$ pLUM01NG <br /> � <br /> OCGUP�NLY NO OiSiMtlES OCCUPANTIOAD BASEMENT MECM�NICAI i <br /> GROUP <br /> ❑YES ❑NO � <br /> FINESPRINKLERREO'D �E�SON ADD�IIONALPIMlCIIECK � <br /> T� <br /> 1 <br /> oiNEn <br /> FIPEAURMREO'0 RE�50N � <br /> S1�1C O111101N0 SIIfIC1U0GE <br /> rrPeorr,or+sr rinNs�rrnoveoor CITYOFEVERETT runncwonres ', <br /> �,��( LOCAL SALES —1— <br /> u.te � . TAX CODE IS J105 TOTAL � _ <br />