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APRLIC4TIOr� FO'R CONSTRUCTIVN! PERMITr <br /> CITY OF EVERtTT•BUILDING DIVISION GC���� <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 � <br /> ❑ OEMOLITION ❑ COMBINATIQN ❑ UUILDING ❑ MECH.ANICAL ❑ PLUMBING ,�SIGN <br /> PROJECTADDRESS: j(>/o2/ ,�U�y'G'�/��=�J %v�9Y <br /> �.SGE�Kci'� <br /> vAaTti�»25 q!5-/� y" R�L 5 ul� r7rL�E✓�tt �1YO�S .,ZO(o -�HS3 �-/lcab <br /> OWNEN M�RAODfiE55 Glh ZiP PHONE <br /> C�NO/Un) � S.qn,�'S ;28i/ �" AJE a1c5r h`l/��tL'IT 9fr?aY 7y2 - 7KlU <br /> TENANT M�ILA�DRCSS �j.(i� C—/p� GITY 71P pHONE <br /> ARGHI�ECT OR OESIGNER MMl ADUPE55 CITY 7��` PHONE <br /> /�?H4GiE _S�,_,u5 /r.-or�.�c�v�UGe�15T�/-A r3/Li/Ai(�/ii1M 4YzzG 3G�v�4�5c�-vui5� T�;q�+t=SR' 047_kC <br /> ` GENEN�IGONTRACTOR M�IL�DDRE55 WLY 21P PIIONE SI�7ELICFN$E• <br /> N�H �/��7 7 <br /> MECHANICAICONTRACTOR MAIIAU�RE55 Cltt 7.I� PMONE STATEUCENSE� <br /> i <br /> i✓/ -} <br /> PLVMBINGCONTH�CTOR MAILADDRE55 CIIY ZIP pNONE STA7ELICENSE� <br /> CONTMCT PPICE OF WpRK <br /> � 'Z��� `� OOU HEATING SYSTEM: ❑ GAS � ELECTRIC ❑ <br /> DESCRIBE WORK AND SOUARE F00 AGE�NVOLVED Cl NTACT PEp50N AND PMONE NO. <br /> _7�l5ifl(.L !�s/.7n/Nt L CL- / n/ N :Ci+ - ,Vc.�n/ ,3L^ - lvSU - 9 b-.� <br /> lA ' a <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PAOPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> " r 2E � - WORK WILL BE COMPLIED WITH WHETHER SPEGFIED HEREIN OR <br /> l'eGAlOESGRIP'fIONOFPROPERtt(S��OWNBELOWOpATf�GHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oi___eu�cK 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 BY THE <br /> OWNEfi OF THIS PROPERTY TO PERFORM THE WORK FOF WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL Tti(I.D.NUMBER CONTRACTORS LAW 10.27 RCW AND 296200 WAC. <br /> LONSTRUCi'IONLOANCEND'cN AU�RESS.IELEPHONENUMBER x �Gi�� 1��--�� IZ/�G��G <br /> SIGH�TU E DAT <br /> CITY B�SINE55 LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOIIE'� � A/C-A/HNDLG UNRS ' <br /> BA7'HTUB ; FORCED AIR SYSTEMS ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNITHEATEFS ' <br /> KITC:HEN SINK h DISP � CLOTHES DRYERS � <br /> DISf1WASHER � RANGE HGOD ' <br /> � LAUIVDRY TRAY � WATER HEATER � <br /> CLOiHES WASHER � WOOD STOVE � <br /> URIPIAL ' MEfAL FIREPL4CE(WOOD BURNING) ' <br /> DRIMKING FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) i <br /> FLOOR DRAIN � GAS FIREPLACE ' _ <br /> BACI(FIOW PREVENTERS i GAS RANGE i <br /> SINK(SERVICE-BAR.ETC.) � GAS PIPING � <br /> EXHAUST FAN <br /> _ � <br /> � � <br /> - � � <br /> � ' <br /> SUB TOTAL E ; SUB TOTAL S ; <br /> PERMIT E � PERMIT S � <br /> TOTALFEE E ' TOTALFEE E ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB�CN AE�RSETBACK SIDESETB�CK �LANCIIECNNUMOER FEF �� �ECEIP�NO <br /> Nn nln ,uA �J� 7J`� � <br /> USE20NE� 'IW��AEA ..t V�C�Ni51iE FEES VALUATION FEE <br /> — — ' z 7 y- ❑YE$ (] NO pWIDING 7 � � <br /> MEIGHTyW ITATION NO OF DW'cIIING S�ZE OF BLOGR.I — � <br /> �'/ �% UNIfS �� PLUMOIN6 i <br /> ��� <br /> OCCUPANCY �q OL SIpaES OCCUCANI LO�D BASEIAENi NEC���HICnI. ' <br /> GRWP � <br /> ❑YES O MO � <br /> fIHESPRINNLERREO'D �EASON �OU�IIONAL�`I�NL�I(;CN I _ <br /> om[n � <br /> � <br /> � <br /> FIREALARMREO'D RFASON � ///��� <br /> STp1E OUIl01N6 SIIRLHn(iGE —_ i� <br /> r <br /> TYPE Of f.ONST PL�YSA�Pf10VE00Y CITY OF EYERETT �tlpl If,VJO(1NS � <br /> �IM LOCAL SALES --�— <br /> ��rE �y �G1 � TAX CODE IS 3105 70TAL <br />