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APPLICATICS FOR CONSTRUCTSIN PERMIOL <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET E EVERETT. WA 98201 E 257.8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING &"SIGN <br />ADDRESS <br />MITER I MAILADDREss V CITY Zw PHONE <br />CIN[TY ederekSOA )/JraYD' E✓erpce e a%Ir g8o2o3 EH.�5,63ggC,33 <br />FHCNE <br />G✓t✓etl o✓a� My'z2SE✓%rewxvc E✓c✓e N�ao3 91L, 33q 9033 <br />AUAADwESS crtr zwFpk <br />A/FoArsSRI IN A/Lk <br />NECHANICALCONTMCfOR WAADDREss CITY ZIP PHONE STATE LICENSEE <br />FWMBOG CCIITIWTOR MAILAODRESS Cm ZIP FIIDNE STATE LICENSEE <br />CONTRAGTFRCE OF VCPK moo <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIES YIKOX AND s0UM1E FOOTAGE D VED• <br />COHTArJPERS0NANDPCIIEN0. <br />Aw ax 0 <br />/ iiiYl� �pAd? 2 <br />/ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />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 BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA CTOR�S LAW 18.27 RCW AND 29�6.200 WAC. <br />X�dC C� �/31�o� <br />FFI P oUSE CIF SUEDKu <br />LE04 CEsCRPTCM OF PROPERTY (SICiVN SELOWOA ATTACH 7W COPIES) <br />LOT BLOCK a <br />FAECEL MID tRMBER <br />CONSTNUCfIONIOANlEHOERAWRESATEIEPNONENDLIOER <br />S NRE OA E <br />n -A a 2?qA <br />cmeusE+Ess LKEnsE No. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />VC—AIHNDLG UNITS <br />i <br />BATHTUB <br />FORCED AIR SYSTEMS <br />I <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />I <br />UNIT HEATERS <br />I <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />j <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />I <br />WATER HEATER <br />CLOTHES WASHER <br />II <br />WOOD STOVE <br />_ <br />URINAL <br />I <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT (WOOD BURNING) <br />i <br />FLOOR DRAIN - <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />I <br />EXHAUST FAN Y iI <br />I <br />j <br />I <br />SUBTOTAL S <br />I <br />SUBTOTAL S <br />i <br />PERMIT S <br />i <br />PERMIT 5 <br />vi <br />TOTAL FEE S <br />TOTAL FEE 5 <br />FOR OFFICE USE 014LY: <br />FRONTSETBACK <br />WAPISEmysm <br />SETBKK <br />e <br />PLAN CHECK NUMSER <br />fEE / ,�� <br />RECENTNO <br />�F <br />C) <br />�� <br />USE ZONE <br />LOTAAEA <br />VAC.WT SITE <br />FEES <br />VALUATION <br />FEE <br />g-2 <br />ons <br />wmw <br />7-� <br />HECHT U1MAtCN <br />NO <br />SIIEOF BIDGTI. <br />S t`� OAS•6. <br />"as/✓// <br />. Ajn <br />RUMBBC <br />NOCFSCRE,. <br />OCCUPANT LOAD <br />BASEMENT <br />COCCCCUUPFANCY <br />MECHANICAL <br />AYES ONO <br />ADOITCIIA "CHECK <br />FOE SPRBAGER REO O <br />PEA5011 <br />OTHER <br />FOE AIAHU PEOD <br />REASON <br />STATE BUIIgIC SURCHARGE <br />lj <br />TYFEOFCOnsT. <br />PWISA Er <br />CITYOFEVERETT <br />FIALCYCRKS <br />/ <br />LOCALSALES <br />TOTAL <br />` G�. <br />TAX CODE IS 3105 <br />pA,,E <br />