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i', � <br /> l�PPt,ICAT10.� FOR CONSTRUCTI,.JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 • (425)257-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAI ❑ PLUMBIN(3 ❑ SI(iN <br /> PR CTADDRESS: �ZI <br /> OWNER ,/ , M�ILADDRE55 � C�TY Z�P PHONE ���— <br /> OS�i d � /„f a . <br /> TEN�NT MNl�00RE55 GITV ZIP PHONE <br /> �RCHITECTORUES�GNER MAIIAD�RE55 GITY ZIP PNONE <br /> GENER�LCONTp�CTOR MMLADURE55 CITY IIP PIIbNE CGTELICENSE• <br /> MECNAN�C�LCONIHACTOR MAILA Ei5 CITY ZIP PHONE STATF.UCENSE� <br /> PLUMBMG CONTR�f,TOR M�IL AOOPF55 GITY IIP PHONE ST�TE LICENSE� <br /> CONTMCT PRICE OF WORK <br /> HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> OESCRIBE MIORK�NO SOUARE FppT�6E INVOIVED CONT�CT VERSON AN�PHONE NO <br /> I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION ANU KNOW THE SAME TO BE TRUE AtJD CORRECT ALL <br /> PROFOSED�� F BU��on+c PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALD SCRIPTIONOFPROPERTYISHOWNBF!OWORIIRAGMTWOCOP�ES) NOT. THE GRANTING OF A PERMIT DOES NOT PHESUME TO 61VE <br /> ior e�ocK ov AUTMORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAI LAW REGULATINd CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THA7 I AM AUTHORIZED BV THE <br /> OWNEa OF THIS PROPEFiTY T�1 PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE ANU I COMPLY WITH THE STATE <br /> PARCEL T/Jf I.D.NUMBER <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> - - G <br /> CONSTf1UCTION LO�N IEN�ER./�WRESS.IELEPHONE NUTABEH � x <br /> SIGNATURE D�iE <br /> pTY BU9NE55 LICENSE NO <br /> PWMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR REM FEE NO. TVPE OF EGUIPMENT FEE <br /> WATER CLOSET(TOILEn � A/C—ARiNDLG UNRS ' <br /> BATHTUB ; FORCED AIR SYSTEMS i _ <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNIT HEATERS ' <br /> KITCHEN SINK d DISP � i CLOTHES DRYERS � <br /> DISHWASHER � RANGEHOOD ! <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL � METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR ORAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; GASRAN3E _ � <br /> SINK(SERVICE—BAR.ETC.) � GAS PIPING ' <br /> � EXHAUSTFAN <br /> � <br /> � <br /> � <br /> � <br /> � <br /> � <br /> � , <br /> SUB TOTAL S ; SUB TOTAL S ; <br /> PERMIT S � PERMIT S � <br /> TOTAIFEE S ' TOTALFEE S '_ <br /> FOR OFFICE USE ONLY: <br /> FRONT SFTfl�CK RERR SETB�CK SIUE SEfB�CN �LAN CIIECK NUrAP[R �EF REf.FIPT NO <br /> USE 20NF I OI APEA V�CANT SIIE FEE VAIUATION FE__ E r__ <br /> i <br /> ❑YES ❑ NO BUII�INf. i <br /> NEIGHI I IMIipION NO OF DWELUNG SIZE OF BLOGRI � <br /> UNItS PLUMP�NG � <br /> �_ �— T <br /> OGGUPFNCY NOO�SInPIkS 0(:CUPAMl04D B�SEMENI MFCIUNiC/1 <br /> fROUP — -- ---- -' <br /> ❑VES ❑ Nn � <br /> ADDI IIONnI.Pl RN G��f.GN � <br /> fIRESPRINKLERREO'0 �FASON �— <br /> OIHER <br /> FIRE AIARM RE�'D AFASOV <br /> S1q1E OUilf)iNG SIIfiGHARCE <br /> _�." ___�_ <br /> fYPE Of f,pNST �f�N$APPPOVEDBY CITV OF�VERETT PIIflI If.WOPNG � <br /> LOCAL SALES - -- ----�— <br /> �ATE TAX CODE IS 3105 io7n� <br />