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APPLICAT101r FOR CONSTRlJCT1uN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETf, WA 98201 • (425)257-8810 <br /> ❑ DEMOLITION ❑ COMBINATION � BUILDING . ❑ MECHANICAL ❑ PLUMBING O SIGN <br /> PROJECT ADDRESS: — -�'�`-Qe <br /> OWNER M�ILAD�AE55 CI ZIP PH NE <br /> .L�,2?,v« �30 �oo°�'�-v`�-�F �olo c��'oo � s3 -o.3a <br /> TENA T T_ MRILp0�E55 GITY 2�P PIIONE <br /> �'�im�c� <br /> PRCHIiF.GT OR DES�GNER MAII�DONE55 Cltt Z�� PHO�vE <br /> GENEf14LCONTRACTOR M�ILAODRE55 CITV 71P PIIUNE SIAiELIC[NSE• <br /> MECHRNICALCONTi7ACTOR MAILA�RE55 Cltt 21{` PNONE STATF.LICENSE� <br /> PLVMBINGCO�f,TOR M��SS�� / ��T�' 21P PHONE STATEUCENSEi <br /> CONffiACT PRICE OF WORN HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> . DESCR16E WOFK PNO SOUA�E FOOTAGE INVOLVED GONTACT PERSON�Np f NONE NO <br /> ` � � � <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 /> PFOPOSE.O USE OF BUILDING pROVI510NS OF LAWS AND ORDINANCES GOVERNING TH�S TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIfIEO HEREIN OR <br /> IEGPL0E5CRIPTIONOFPROPEPttISHOWNBELOWORRTTACHTVOLOPIESI NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �pr o�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNEA OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> . CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> . P�RCELTA%I.D.NUMBER <br /> CONSTRIICTION IOAN LENDER.ADDFESS.TELEPHONE NUMBER x <br /> SIGNATVNE DATE <br /> CITY BUSINE55 LICENSL NO <br /> PLUMBING MECHANICAI <br /> ' NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNRS ' <br /> BATHTUB ' FORCED AIR SYSTEMS � <br /> � <br /> LAVATORY(WASH BASIN) i HEAT PUMP ' <br /> � UNIT HEATERS � <br /> SHOWER � <br /> � KITCHEN SINK&DISP - � CLOTHES DRYERS ' <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL � METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOF7 DRAIN � GAS FIREPLACE � <br /> BACKFIOW PREVENTERS � GASRANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> � EXHAUSTFAN � <br /> i � <br /> � ' � <br /> i <br /> i � <br /> � <br /> � <br /> � <br /> SUB TOTAL S i SUB TOTAL $ � <br /> PERMIT 5 i PERMIT S � <br /> TOTAIFEE S ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FR�NTSFTIfACN RF.ARSF.TBACN SI�ESEfBACR �lANC11ECKNUMFIF. <br /> FEF fiECFIPTNO <br /> F ES VALUATION FEE <br /> USE ZONF l OI AREA VRCANT S�TE ; <br /> ❑YES ❑ NO OUIIDINC <br /> ❑EIGI/TIIMITATION �O.�DWELLING SIZEOFBLOGR� p�pM91NG � <br /> —.�_-- <br /> i <br /> OCCl1PANGY NO O�SIOBiFS OCCUPANILO<p BASEMEN/ MEf,H4NiC/l � <br /> i <br /> GROUP —y <br /> ❑YES ❑ NO <br /> �D�IlIONAI.PLAN C��CCK � <br /> FIRESFRINKLEFREO'D �Fn50N � <br /> OiREe <br /> FIFEAIARMREO'0 AF�SAV � <br /> SIAIG 811110�NG SIIfiC11ARCE <br /> Tvre or r.a+sr rtnNs nrraovEn ov CITY OF EVERETT �uni ic wonKs _ <br /> LOCALSALES <br /> opTE TAX CODE IS 3105 TOTAL <br />