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i ppPLICATII,.p:al FOR CONSTRUCI dN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION �C���� <br /> 3200 CEDAR STREET•EVERETf,WA 98201 •259-8810 � <br /> ❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL ❑ PLUMBIN`�Q � SIGN� <br /> ppOJECT ADDRESS: �'S�3 � ��Ar�� W �-��'�� ��11�0 S„ 1_ � �',- <br /> M MAfl 320 �o�'~Av N� �40�0 B¢�'k�hr.R �1A °I8�4 71�1a•453• G3ZA' <br />� MIIILADORE55 CIiY 21P PHONE <br /> pWNEN <br /> vN owh AT �813 <br /> TENMli MNLMURF.55 CIIY ZIP f'110NE <br /> N�J� <br /> �qCNITEGT OR GES�GNEA MAIL ADDREGS LITY ° 7.IP PNONE , <br /> GENEF�LCCWTRACTOR ILADDPCSS /� <br /> CiIY 7�P Pi10NE $f�TEIICEN$E� <br /> �r'�-'-�y���10 ( �a2�}na r�cn� a/��a��cnQ� <br /> ��n. ��p PHONE STATE LICENSE� <br /> MECHM':C�LCONTR�CTOR MAIL�WRE55 <br /> PLUYB�NCCONTR�CTOR M�ILADDRE55 Citt Z�P PHON1: STATELICENSE• <br /> I' cor+r�ucrraiceovwonK �yL' O�A HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> II `T GONTAAGT PERSONA�NO APHONE NO <br /> pEkRiBEWO�N�NOSOU�AEFOOTAGEINVOWEO,`LU�N�N6 �N �V n�^ �`�N� �� �� ��09 <br /> N�w 94.n+�S�NG w�+U�. �$o��lV U.Q.� <br /> w <br /> ww�--, Po�R- 3tA9 Bv��.O RC�rR�olvl <br /> W�R�N SCUPE- I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> 'Pp��'�ot�lS,T- �P¢ �uKG 6N S AppLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROPOSED USE OF BUILDING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> iZ�-'�A1L S'AL� WORK WILI BE COMPIIED WITH WHETHER SPEGFIED HEREIN OR <br /> LEG�LOESCPiPT10NOFPROPERNI�OWNBELOWOR�TUCHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> I' AUTHORITY TO VIOLATE OR CANCEL THE PFiOVISION OF ANY <br /> inr B�ocK �F OTHEF7 STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> �{} PERFORMANCE OF CONSTflUCTION.THAT I AM AUTHOfiIZED BY THE <br />�` - � ""' � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WH�CH <br />� APPUCATION IS MAOE AND 1 COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 29620 AC. /� <br /> PARCELTA%I.O.NUMBER `/� � /�Z�/� <br /> 41U2- C�UU - �ot - �oo8 n�_.r �� <br /> CONSTRUCTION LOAN LENDER.ADORESS,TELEPHONE NIIMBER x f��t�� <br /> II N I A SIGNATURE D�7E <br /> T� <br /> I CITV BUSINE55 UCENSE N0. <br /> IPLUABING MECHANICAL <br />` FEE NO. TYPE OF EOUIPMENT FEE <br /> NO. TYPE OF Fl%TURE OR ITEM � <br /> WATER CLOSET(TOILEn � A/C—MiNDLG UNRS <br /> BATHTUB ; FORCED AIR SYSTEMS � <br /> � HEAT PUMP ' <br /> LAVATORY(WASH BASIN) � <br /> SHOWER � UNIT HEATERS <br /> KITCHEN SINK 8 i�ISP i CLOTHES DRYERS ' <br /> DISHWASHER � RANGEHOOD � <br /> � LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOODSTOVE � <br /> � MEfAL FIREPLACE(WOOD BURNING) � <br /> URINAL � � FIREPLACE INSERT(WOOD BURNING) � <br /> DRINKING FOUNTAIN ' i <br /> FLOOR DRAIN � GAS FIREPLACE <br /> BACHFLOW PREVENTERS ; GASRANGE ' <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> I � EXHAUSTFAN � <br /> i � <br /> i � <br /> I � i <br /> I � � <br /> � <br /> i <br /> � <br /> SUB TOTAL a ' <br /> • SUB TOTAL S i � <br /> _' <br /> PERMIT S <br /> PERMIT S TOTAL FEE 5 ' <br /> TOTALFEE S <br /> FOR OFFICE USE ONLY: �EE aer.eirr r+o <br /> FRONT SETBACK REAP SETBACK SIDE SETB�CN PIAN CIIECK NUMBER <br /> �� VA UATaICOJN FEE <br /> USEZONE IOTAREA VACANTSIfE ; <br /> 2 � � � <br /> ❑YES ❑ N� OUILOIN6 ' <br /> i <br />� NEIGNTL141TATION NOOFDWELUNG SIZEOFBLDGR.I � �' � <br /> UNITG ! �)/ff) PLUMOING <br /> � /`7(/ �� <br /> BASEMENT � <br />� OCCUPANLY NO Of$IOuiFS OGCUPANT LO�D MECHANIC�I � <br /> GRO P /� JI• ❑YES �NQ i <br /> � � R�DI110N�L�1�C11F.LR <br /> �i-- <br /> FIPESPflINK�ERREO'D REASON A/ � <br /> IIV/_�, �/A'�i� O7HER <br /> YTi 4/w <br />� FIREAIAR�EO'D REASON �� <br /> I� y��.-;./�,/� S7ATE BUIlO�NG SIIRGHRIlOE __ � <br /> Fii � �1�� �j { <br /> � <br /> TlPE OF f.ONST PLANS�P7�YED OV CITY OF EVERE7T �U911f,WORKS �_ i__ <br /> I .�i� � lr( LOCAL SALES a a ' SO <br /> ..Ef/�/ o�TE 1Z G TAX CODE IS 3105 7oTAL <br /> ��.�._�.��. _ <br />