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APPLICATIG.J FOR CONSTRUCT.JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS�_bL2� �v-2�,t2Q� �fy� <br /> � _ � <br /> ONTlE� MMLAWRES$ ��N z�P PHONE <br /> C�QT�_1CST�rtt,�c...a� <br /> TENANT y/J�MNLAOORE/55/ 1 CITY / /+ ZIP VNONE /�/� r .��(/ <br /> AfiC TECT OR�DESIGNER " L�R�ODRE/ �J �//(� / !V( Iry V L/ �//D � �(PH`^� L(1' "'`� /� �10� <br /> GENEH/�IGONTR�GTIXi MAILAUDRE55 CITV IIP P110NE SfATEIICENSE� <br /> �11ETVtLSw..}hs 7l I(o Z2.oTM5�5�..� �l�T WrF�i�doc23 �-36Z`.343o (W�S W�z 1'i I U^ <br /> YECHANICALCONTP�CTOR M/JLAWHE55 CITY ZIP PHONE SIATEUCENSE� <br /> PIUMBING CONTRACTOP M�ILAOORESS GIN ZIP PHONE $TATE UCENSE� <br /> CONTMCTPRICEOFWWIK � HEATING SYSTEM: �GAS � ELECTRIC ❑ <br /> OESCRIBE WOfiK�NO SOU�RE FOOT�GE�NVOLVED CONTALT PERSON�HD VHONE NO <br /> (LK C'� � �oL •n J <br /> Z. O <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AIdINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CC'RRECT ALL <br /> P{pPOSED USE OF BUILDINO PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> ��ni�lL,fL WORK WILL BE COMPUED WITH WHETHER SPECIFIEO HEREIN OR <br /> ��,p�e�p�pnpHpFppppEpTy�$�qWN9F,�pWOqATfACNiWOCOPIE5) NOT. THE ORANTING OF A PERMIT DOES NOT PRESUMC: TO GIVE <br /> �oT B��K aF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE Ofl LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED B�'THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICF! <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW ANO 296200 WAC. <br /> PAi10ELTA%I.D.NUMBER / I <br /> CONSTRUCTION IO�M LEIIDER.�UORE55.TELEPHONE NUMBER x��1�1 A II. 1�C\ �J�YJ+�/� �� 'C��I�J <br /> �,��.r.��._�y..�.__ D�TE <br /> SIGNATU�IE <br /> qTV BUSINE55 UCENSE NO. <br /> PLUM61N6 MECXANICRL <br /> NO. TYPE OF Fl7(Ti1RE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATERCLOSET(TOILEn � A/C—MINDLGUNfTS• ' <br /> BATHTUB ; FORCED AIR SYSTEMS � <br /> LAVATORY(WASH BASIN) � HEAT PUMP ' :I <br /> SHOWER � � UNITHEAT�RS ' <br /> � <br /> KITCHEN SINK 6 DISP � CLOTHES DRVERS � <br /> DISHWASHER � 3 RANGE HOOD ' <br /> UIUNDRY TRAY ; WATEH HEATER � <br /> CIOTHES WASHER � WOOD STOVE ' � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN i FIREPLACE INSEFiT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPIACE ' <br /> BACKFLOW PREVENTERS ; GASi7ANGE � <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING ' <br /> � DCHAUST FAN � <br /> i <br /> i <br /> � � <br /> i � <br /> � — <br /> � <br /> SUB TOTAL S ' SUB TOTAL S � <br /> � <br /> PERMIT S � PERMIT S � <br /> TOTAL FEE E ' TOTAL FEE S Z ' - <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK AE�R SETBACK SIDE SET6�CK PIAN CII��%�R�_ fEE RECFIPT NO <br /> (J <br /> USE20NE IOTAREA VAC�NTSITE FEES VALUATION FEE T <br /> ❑YES ❑NO � <br /> BIIIlDIN6 � <br /> HEIGMT UMITATION NO OF DWELUNG 512E OF BLOGRI � <br /> i <br /> UNIT$ p�pMBING �_ <br /> i <br /> OCCUPANCY NO(K51[NtlES OGCUP�NTLO�D 9ASEMENT MECNnNIC�I <br /> GROUP - <br /> �YES ❑NO <br /> FIRESPRINKLEflREO'D REASnN pOD�T10NRL�'UNGIF.GN _ <br /> O7HER <br /> FIREALMMREO'0 RE�SON I <br /> STAIE BWLDING SIIRCN��GE � <br /> __ r— <br /> iYPE OFf,ONSi PL�NSM P[IVEDBY CITY OF EVERETT �11911f;WOPKS _ � <br /> �� ���� LOCALSALES �— ' <br /> o�te `�- \y -�� TAX CODE IS 3105 70TAL � <br /> � <br />