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APPLICA,VIOiv FOR CONSTRUCTIvN PERMIT <br /> CITY OF EVERETi• BUILDING DIVISION <br /> 32Q0 CEDAR STREET• EVERETT,WA 98201 • (425)257-8810 <br /> ❑ DEMOLITIOk ❑ COMBINATIdN � BU�LDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTnADDRESS:�(_ - ' / !�(3 F6�GN9tt�t <br /> �z(��/� f� l3 i h �'iv r Y a � Cloi'e t�n a.a SK o/�'h 9 �eaifeG- wa�- <br /> py/qEp' • MAILA�ORE55 CITY ZIP HONE � <br /> n/�,:�f,��� ;�., �.2/� �2�� �� <- �p L� v.�!/Y� �,�,� G.�-�- /y�3 <br /> TE NT 1AAl1.�DDRE55 GITY ZIP PNONE <br /> PRCHITEC OR E��� MMIADDRE55 C��Y ZIP PHONE S �` <br /> R� �',�v, sfi r�r T,��T�6'�C��L�Q���.�,LJ��-� !(-�13 �nl �-�G <br /> GENERpLCONiMGTOR MAlLAU0RE55 GITY / / 71P PH�� JME SfA7ELICENSE� <br /> MECHANICA��ONTRACTOR IA�I�A�DRES$ C�Tv 21P PIIONE S7ATF.liCENSE� <br /> PLUAIBING CONTRACTOR MPIL ADDFESS Cltt ZIP PHONE STATE IICENSE� <br /> �� <br /> V ` <br /> GONTMLi PRICE OF WORK HEATING SYSTEM: �GAS ❑ EIECTRIC ❑ <br /> D'cSCRIB� E WO�K I�NO SQU�AE FOOTAGE INVOWED WNTACT PF.PSON AND PNONE NO �L� � �� �/ <br /> 2 6 �. C' <br /> G ' I �S_.�� cJ �� � <br /> a � <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 /> PFOPO/SF.D USE OF BUILDI�I7Gt � PROVISIONS OF IAWS AND ORDINANCES GOVEFNING THIS TYPE OF <br /> �L-!G'oPl't�G{ �G ��^ < <f' YVORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRI IONOFPROPEPNISHOWNBELOViORATTALHiWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> i B��K oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> �� �� � n O7HER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> e� GQG C��� P[RFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> i OWNEF OF THIS PROPERTY TO PERFOFiM THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS lAW 1827 RCW AND 296200 WAC. <br /> PARCELTA%ID.NUMBER -pDD <br /> ^ � `-o.� ,��� <br /> CONSTRUCTJO�nN LO�N LENDEP.A�URE55.TELEPHI)NE NUMBER �^'—'�r <br /> Sr /T ' SIGN�TUFlE �j DA1t �� <br /> � <br /> CITY BUSINESS LILENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—NHN�LG UNITS ' <br /> BATHTUB ; FOFlCEDAIRSYSTEMS � <br /> LAVATORY(WASH BASIN) � HEAT PUMP ' <br /> SHOWER ' UNITHEATERS � <br /> KITCHEN SINK d DISP � � CLOTHES DRYERS � <br /> DISHWASHER � RANGEHOOD � <br /> LAUNORY TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOODSTOVE ' <br /> URINAL � METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS � GASRANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING ' <br /> � EXHAUSTFAN <br /> � � <br /> i <br /> i <br /> i <br /> i <br /> � i <br /> � <br /> i <br /> i <br /> SUB TOTAL $ ' SUB TOTAL b � <br /> i <br /> PERMIT $ i PERMIT S ' <br /> TOTALFEE S � TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FRONTSFTPRLN RF�RSETBALK SIDESEfBACN �LANCIIECKNUMFI[R FEP f1fCE1PTN0 <br /> USE 20NF 1.01 AREA ��CANT SITE FEES VA�UATION FEE <br /> -�__ <br /> 1 i <br /> ❑YES ❑ NU OUIl01Nf. / � <br /> HEIGHT I IMITATION NO.OF DWELLING $IZE OF BIOGIII � <br /> IINII$ { / P�UMOING _ ___�__ <br /> / U <br /> pGCUPANCY NO(!�SIOPiFS OCCUPANi LO4D BASEII�ENi MFCNnNlf.nl. � <br /> f.ROUP / 7 -- � ^ <br /> �. ❑YES NO i <br /> ��DI110N/.I.PIAN C��[GR _ <br /> FIRE 5 RIN LER REO'� �Fn50N _. - � <br /> �c5 ,EXSr�. Si Jr,;ro on�En � <br /> FlREAIARMREO'D AF450V � <br /> Y�S (�' Kb �Z"y� $�s T�/h 5*ai�nunnwu�unc��nncE _ ,� <br /> rvvE or r,o�+sr / r�nas nvrn �ov CITY OF EVERETT runur,wo�KS <br /> � /� , / �,�� LOCAL SALES — �— <br /> r �V oATE✓`o � ' TAX CODE IS 3105 TOTAL �' <br />