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APPLICATI�a�! FOR CONSTRUC1 .Q�di PERMIT <br /> CITY OF EVL"-RETT•BUILDING DiVISION � <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259-8810 <br /> fl DEMOLITION fl COMBINATION f� BUILDING MECHANICAL fl PLUMBING (� SIGN <br /> PROJECT ADDRESS <br /> 2 0 �oi.6Y xtuawE <br /> ���� MAILAODRLSS <br /> �� I�G Z►7�� cm zir /� r��orve <br /> T@N T T MAILA�bPE55 �� •�� <br /> LIiY ZIP PIIONE <br /> .��„-.,�.. . P�e�i�T/Es f�II <br /> � S�n�i� <br /> AR 111TEGTOROESIGNER MAILMDPESS CITY ZIP PNONE <br /> �T��� <br /> GENcq/qCONRIRCTOR MRILADDPE55 Cltt ZIP PIIONE STATEUCLNSE� <br /> �DL Go� <br /> MECHnNILALCOMRRCI0f1 MRILADDRESS C17Y ZIP PHONE STATELICENSE� <br /> uN�1�1tsr1Y w►cr�Lr���.l.�l2�c�,a� �tyJ�ir�B133�et�rl��3� <br /> PL MBING���{pq MAILA�DRESS LITY ZIP PIIONE <br /> ���— STATE UCENSE 1' <br /> � � <br /> CO ACT PAIGE OF WOOR — <br /> HEATING SYSTEM: f l GAS ❑ ELECTRIC ❑_ <br /> UESCR BE WORI N SOU�RE FOOTAGE INVOW[0 CONi�CT PEHSONAND PIIONE NO. <br /> ��I..�_��1 — <br /> I HEP.EBY CERTIFY THAT I HAVE fiEAD AN� EXAMINED THIS <br /> raoroseo use oF euuoiNa APPLICATIUN AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEG�LOESCHIPTIONOFPROPEBTY�SNOWNBELOWORATTqCH7WOCOPIES) W�RK WILL BE COMPLIED WITH WHETHER SPECiFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCN or AUTHORITY TO VIOLATE OH CANCEL THE PqOVISION OF ANY <br /> OTHER STATE OR LOCAL lAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2E0 BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PARCEL TA%1 U.MIMUER CONTRACTORS LA 27 RCW AND �200 WqC. <br /> CONSIRUGTION LO�N lENOER,AODRESS,TELEPNONE NUMBER X � ��/���.C� <br /> SluwnN E D�� � <br /> CITY OUSINE55 LICENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUpE OR I7EM FEE NO. TYPE OF FI%TURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � AIC—ARiNDLG UNITS—H.P. � <br /> BATHTUB � FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATOFY(WASH BASIN) ' <br /> � HEAT PUMP � <br /> S�10WER � 11NITHEATERS—B.T.U. M i <br /> KITCHEN SINK 8 DISP ; CLOTHES ORVERS � <br /> i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRYTRAY ; RANGEHOOD � <br /> � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL � WOOD STOVE � <br /> �RINKING FOUNTAIN � METAI FlREPLACE(WODD BURNING) ' <br /> � <br /> FLOOR DRAIN � FIREPLACE INSERT(WO00 BURNING) � <br /> BACKFLUW PREVENTERS ; GAS FIREPLACE � <br /> � <br /> SINK(SERVICE—BAR,ETC.) i GAS RANGE , <br /> ' GAS PIPING � <br /> i EXHAUST FAN � <br /> � � <br /> � <br /> � � <br /> � <br /> � � <br /> SUBTOTAL S � SUB TOTAL S ' <br /> _ PERM�T $ i PtRM1T E � <br /> TOTAL FEE S � TOTAL FEE S � <br /> FOR OFFIC2 USE ONLY: <br /> FRONTSETAACN REnRSETB�CK SIDLSETBACN PIANLUE K MOEfl FEE RECEIPTNO. <br /> � r <br /> US[20NE LOTAREA VACANTSIiE EES VALUATION FEE <br /> flYES O NO <br /> OUILDING <br /> IIEIGHTUI.IITATION UNIT�OWELLIN6 SIZEOFBLUGRL <br /> PLUMOIN� <br /> OCCUPANCY AV OFSfOWFS OCCVPAYTIOAD BASEMENT MECIIANICAL <br /> GROUP <br /> ❑YES ❑ NO <br /> FlREALMMRE4V qEASON ADDI7IGNALPLAMCIIECK ' <br /> OiIIER I <br /> GtRE SPRINKLER REC'O pEA50N <br /> STATE BUILDMG SUflCH�RGE j <br /> � <br /> 7VPEOFCONSi PUNSAPPqOVEDBY CITYOFEVERETT PUBLICWORNS j <br /> LOCAL SALES —� <br /> onTe TAX CODE IS 3105 TOTAL � <br />