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APPLICATI�.N FOR CONSTRUC'►ON PEi�MIT <br /> C�TY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ,� BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> ppOJECT ADDRESS: � �' '� � <br /> OMNEH Mu�AppRE55 pry <br /> � Z�P MONE <br /> TENIWT n- a ✓ ��l,or, 7 ��' L.���Ni�rri.�es�•,�/_i+n�� 9,Y� ,y� />5"2 iJ:.3/ <br /> ��ooness cnv na v�` <br /> ARGHIiECTOi1DE51GNER M1Ul6O0RE55 �Itt 71P PHONE <br /> GENENµGONTR�LTd1 MAL�DOilESS �IfY 21P PNONE GUTEIICENSE� <br /> ' �3y-���� r-�, i�Y� 2yi�� � <br /> �° s ,� � ��,'.-, ('o :��r -79 ����� s� 9.-�+� � � <br /> MECHANICQCONTR�Q MiV ADDNE55 Cltt pIP PIIONE STATEUCENSE� <br /> PLUTABINGCONTflACTOR Y�ILAOOiiE55 CIIY zlP PNONE ST��ELICENSE• <br /> CONTM�T PipCE OF Wp{iK <br /> � OjJ• U ' HEATING SYSTEM: ❑GAS ❑ EIECTRIC p <br /> OESCIMBE WOfiK I1ND SqMRE i00T�GE INVOLVED CONT�CT f'ERSON AND PHONE NO <br /> ) 1 i ✓ <br /> �.rd; J <br /> � 1 HEREBY CERTIFY THAT I HAVE READ AND E7CAMINEO THIS <br /> � P1qPOSED USE OF BVILDINO � / � APPLICATION AND KNOW THE SAME TO BE TRUE AND CARRECT ALL <br /> S N ' /L PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br /> t�ciucescwrr�a+orraar¢nTr(s�+ovmee�owaRAn�cNrvrocovi¢s1 NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � �ot e�oac oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � y " � . Z � I — / / � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOfl WHICH <br /> APPLICATION IS MADE AN 1 COMPLY WITH THE STATE <br /> PMLELTAXI.D.MIMBER CONTRACTORS LAW 27 C/AND 296200 WAC. <br /> CONSTHIICiIONLOMILENOEH,ADDRESS.TELEPHONENWBER � � � � / 'n'C� <br /> SIG E D�TE <br /> Citt BUSNESS LICENS[NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYVE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn ' NC—A/NNDLO UNfTS � <br /> BATHTUB ; FORCED AIR SYSTEMS ; <br /> UVATORV(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNIT HEATERS � <br /> KITCHEN SINK 8 DISP � CLOTHES DRVERS ; <br /> DISHWASHER � RANGEHOOD r <br /> LAUNDRY TRAY ; WATER HEATER ; <br /> CLOTHES YlASHER � WOOD STOVE � <br /> URINAL � MEfAL FIREPLACE�'VOOD BURNING) � <br /> DRINKING FOUNTAIN i FIREPLACE INSEflT(WOOD BURNING) i <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GAS RANGE ' <br /> SINK(SF.FiVICE—BAR,ETC.) � GAS PIPING � <br /> ' D(HAUST FAN <br /> � � <br /> i <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S ; <br /> PERMIT S � PERMIT f � <br /> TOTALFEE S ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRON�SETBACN REI1N SETBA(:K S�OE SF.TBACK PIAN CIIECN NUMBEN FEF RECF.IPT NO <br /> f—�r'7� � <br /> USE 20NE tor�ae� V�CANT SITE PEECi VALUATION FEE <br /> ❑YES ❑NO OUII�INC �v � <br /> HEI6NTLIMITATION NOOFOWELLING S�ZEOFBLDGRI � <br /> UNIT$ PIUMBING i <br /> � <br /> aC�NLY NP(If StMtlES OCCUPANT IO�O BISEMENT MECN�NIC�L � <br /> ❑YES ❑NO <br /> FIftESPRINKLEHREO'D AEASON A��IIION�Li'L�NC��F.CN <br /> �- <br /> O1HER � <br /> i <br /> FIflEAIAfiMPEO'D REASpN <br /> STAIE BUILDINf.511RL1UfiGE — T`�l <br /> L <br /> TYPEOF(;pNST P�ANSMPPOVEDBY CITYOFEVERETT �'��BIIf.WORKS <br /> LOCAL SALES —�— <br /> o�re TAX CODE IS 3105 TOTAL ! <br />