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APPLICATI('"N FOR CONSTRtf C'�ON PERMIT <br /> CITY OF EVERETT•BUILDING 91VISION <br /> 3200 CEDAR STREET• EVER�Tf,WA 98201 •259-8810 <br /> ❑ DEIAOt.ITION ❑ COM8INATION ❑ BUILDII��O ❑ MECHANICAL � PLUAIl91NG ❑ SION <br /> PROJECT ADDRESS: I �7��� �{^� <br /> V / 1 �SS�yI� �' 'CITY 1 `/1I�iIP�� P Cl,cSn� �'i--1 -I�2L-. <br /> �"'"`'��" .U.�ks - II132 �N�:Rf��.[ lMA-v �C�-���i w/r <br /> 7ENN�T MAK�Dd1E55 �dTY 71P VI/ONE <br /> ARL1111ECTp10E5�GNEP IMILADORE55 CITY 71P PNONE <br /> (S�`-n� ,K oL�h.tE��GRTFTtti%it:'� — ��5fi I.d.Acr.I�f�- <br /> OENEMLCONTMCTOfi MAllA0011E55 C� ZIP PIIONE SUTELICENSE• <br /> MELW WIG1L CONTRACTOii M/JL�DURE55 CIIY ZIP PNONE STATE L SE� <br /> J•��}�• � �,� ��a � ��,^-r-� 4�n�a. �� -s��4�� Pe� -����Q6 <br /> PIUMl�1�p�p(IpA�iOil MA0.A00� SR S r� 1�_B GTY IIP �� ST�TE LICENSE� <br /> �°"T""°T°"�°F"aa` HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> pE9CpME WpqK M!p$pIME F7OT�OE W VOWED CUNT�CT PEHSON AND PNONE NO. <br /> I HEHEBV CERTIF'f THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> rroroset use oF mmar+o PROVISIONS OF UWS AND ORDINANCES GOYERNING THIS TYPE OF <br /> . WORK WILI BE CAMPLIED WITF; WHETHER SPEGFIED HEREIN OR . <br /> �uo��cnwt�ae�a�nr¢arv�yqvmee�owon�n�cHnvoeovies� NOT. THE ORANTING OF A PERMIT DOES NOT PRE�UME TO 61VE <br /> ' i� �� � AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW RE�ULATIN�CANSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BV THE <br /> OWNEq OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONTRACTORS LAW B27 RCW AND 296200 WAC. <br /> PNCEL TN(I.D.NUMBEP <br /> CpNS1qI1CTlp1 LWN LENUER.�WRESS.TELEPIIONE M1M9EH <br /> S�M E D�TE <br /> GTV BUSINE55 LICENSE NO <br /> P���NQ YECNANICAL <br /> NO. TYPE OF FlIfTURE OR ITEAA FEE NO. TYPE OF EGUIPMENT FEE <br /> T <br /> WATER CLOSET(TOILEn � A/C-AMNDLG UNITS ' <br /> BATHTUB ; FORCEDAIRSYSTEMS �_ <br /> UVATORV(WASH BASIN) � HEAT PUMP ' <br /> SHOWER ' UNIT HEATERS ' <br /> � <br /> KITCHEN SINK 8 DISI' i CLOTHES DRYERS � <br /> DISHWASHER � HANGE HOOD ' _ <br /> U1UNDqY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � ' WOOD STOVE ' <br /> URINAL � METAL FIREPLACE(INOOD BURNING) � <br /> DR�NKING FOUNTAIN ' FIREPLACE INSERT(WOOD BURNING) � <br /> � <br /> PLOOR DRAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> SINN(SERVICE-BAR,ETC.) GAS PIPING ' <br /> � EXHAUSTFAN � <br /> � <br /> � � <br /> � � <br /> i <br /> SUB TOTAL S ; SUB TOTAL S � <br /> PERMIT S � PERMIT f � <br /> TOTAL FEE S � TOTAL FF.E S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SE7BACK REAR SETB�CK SI�E SETBACN �'l�N GIIEC1c NUMBE� FEE RFf.EIPT NO <br /> S� <br /> USEZONE IOTAREA VACANTSI�f FEES VALUATION FEE T_ <br /> i <br /> ❑YES � ' '�� gpi�plNG i <br /> NE16HTl1WUT10N NOOFDWELLING SIZEOiBLIXIRI w• j�� <br /> UNITS P�111AOMC cy ' <br /> 1 <br /> OLCUPANCY NO Of S��ES OCCUPANT LOAO BASEMENT MECIUNIf.A/ i <br /> G�� ❑YES ❑ NO i <br /> �ODIIION�I.PIAN G�I(GN � <br /> FIflESPPINNLENREO'D REASON ----�'— <br /> � <br /> 0111E11 <br /> FIREAIMMflEO'0 RE�S(k! � <br /> S1AIE BIIIIPING SUqC1Uf1GE � <br /> __ r— <br /> TYPEOFf,ONST VlANSAPPROVEl1BY CITYOFEVERETT �IINIIf,WOnNS � <br /> ____i_ <br /> LOCAL SALES ---- �1D � � <br /> u�TE TAX CODE IS 3105 TOTAL <br />