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r. <br /> APPLICATIO.� FOR CONSTRUCTIJN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br />' �u ��� ❑ MECNANICAL ❑ PLUMBING ,�SIGN <br /> ❑ DEMOLIT�ON ❑ COMBINATION ❑ BUILDING <br /> ��y{-�,IO�ZI �l�.�dl� <br /> PROJECTADDRESS: (.I i� ' Ca�f�N �`�. � �L� �' S �. � ���hR�� WA�I <br /> ]���R -ri2MR-��%. 1�'JO-46� ��1hHON ISH 9AZ90 33�57 58oa- 743 v`�,� <br /> - ��n, t�p PHONE <br /> M LADORE55 <br /> �a�d�c �� ti� <br /> � 7EN/JJT / MULMDRC55 <br /> CITY IIP PIIONE <br /> ���[_ ( A L E ��TM p�p PHONE <br /> ARLMTECiORDESIGNEA MAIIADORE55 <br /> P110NE SIeTE'.iCENSE� <br /> GEHE�lOONiP�CTOii MML�DDRESS ���Y I�� <br /> ( , / ��n, Z�p pNONE STATE UCENSE� <br /> MELH11tMGlCONTR�CTOp MMLADDFE55 <br /> C'TM Z�P p�NE $TATEIICENSE� <br /> PLUMBINGCONTRACTOR M�R�DORE55 <br /> CpNTMCTPMCEOF WO HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> pE5CPo8E WO�NAND SOl1ARE fOOT/�GE INVOLVED <br /> LONTACT PERSONANO PHONE NO. <br /> �� � <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> ppoposeouse ov au�a�o PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILI BE COMPlIEO WITH WHETHER SPECIFIEO HEREIN OR , <br /> ����yPT�p�p�PpppfpN�SlpymgE�pWpqATT/�CNTWOCORES) NOT. THE (iRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or <br /> e�ocK oF OTHER 3TATE ORVLOCAL L W REGULATIN6 CONSTORUOTOION OR THE <br /> OWNER OF THIS P OPERTY TO PERFORM THE WORK'FOR WHICN ' <br /> ppPLICATI IS MADE AND 1 COMPLY WITH THE STATE <br /> CONTR ORS lAW 1827 RCW AND 296200 WAC. <br /> �� pARCELTN(I.O.NUM9FR <br /> / <br /> � CpNSTRVf;TON LONI LEN�ER.�DURESS.TEL'cPMONE NUMBER x DATE <br /> SIGN E <br /> LITY BUSINE55 LICENSE NO. <br /> ' pWMBINGI MECHANICAL — <br /> FEE NO. TYPE OF EOUIPMENT FEE � <br /> . ' Np, TYPE OF FlXTURE OR ITEM q/C—AMNDLO UNRS � <br /> WATER CLOSET(TOILE� FORCED AIR SYSTEMS ' <br /> BATHTUB ' � <br /> � LAVATORY(WASH BASIN) � HEAT PUMP <br /> � � UNIT HEATERS � <br /> SHOWER � � <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS <br /> � RANGEHOOD � <br /> DISHWASHER � y�q7ERHEATER ' <br /> LAUNDRYTRAY � WOODSTOVE � <br /> CLOTHES WASHER , MEfAL FIREPLACE(WOOD BURNING) � <br /> URINAL � FIREPLACE INSERT(WOOD BURNING) ' <br /> � DRINKING FOUNTAIN � GAS FIREPLACE � <br /> FLOOR DRAIN , Gp,g qqNGE ' <br /> BACKFLOW PREVENTERS � � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � - <br /> � EXHAUSTFAN , <br /> � <br /> � , <br /> � i <br /> � ' <br /> � � <br /> � <br /> SUB TOTAL S � <br /> SUB TOTAL S � pERM�T 5 ' <br /> PERMIT S ' TOTAL FEE S ' ' <br /> � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: FEF (� RECEIPTNO <br /> rur+c�iECKr+uuaen (7 <br /> pppN}$ETBACN RE�RSETBALI( SI�ESETBACIt ���� /� <br /> � = A�lh �O/ � <br /> Z VALUATION FEE <br /> USE ZOne � AREA V�CANT SITE FEES (�� i <br /> C� ' 3�� ❑YES N� pUII�INC �aC/ � � <br /> i <br /> NEIGHT LIIATATION NO OF OWELL�NG SIZE OF BLOO�f� � <br /> 9��q UNITS �� PlUM01NG �� <br /> � <br /> , <br /> OLCUVANTLO�D BASEMENT MECM�NIC�L � -- <br /> OCCUPANC'/ NO 0�Sf(unES i <br /> GRWP ❑YES ❑ NO i <br /> �ODI OON�L�UN GR:CN _ <br /> FIRESVRINKLERREO'D REASON � <br /> 0111E0 <br /> REASON —_ � <br /> qqEAUpM REO'D STAIE BUIl0�N0 SURCN��GE � <br /> TY7E OF f,ONST ��ANSA {�OVED BY CITY OF EVERE7T �11911f,WORNS ___i_— <br /> 'M LOCAL SALES 2 �� <br /> � ` 1 0� � TOTAL <br /> U�TE � H TAX CODE IS 3105 <br />