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,. <br /> APPLICATIuN FOR CONSTRUC110N PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT; WA 98201 • (4251257-8810 <br /> ❑ DEMOLITION ❑ COMBINATION O BUILOING ❑ MECHANICAL ❑ PLUMBING ❑ SION <br /> PROJECTADDRESS:_ /�/5� ��Y;�„` � <br /> -.�� r� .130�r lA N n �a°i� � k4,A�1 ��u��1`a.,�- S�2 od� 3s a a°S' � Z <br /> MqL ADOqE55 CITY <br /> I�P GHpNE <br /> TEN�NT M,y�ADORE55 <br /> ��TY z1P PNONE <br /> AR�MITECTORUESIGNER M�IlA00RE55 <br /> ��tt 71� PHONE <br /> GENERQCONTMCTpq M�I�A�DRE55 -� <br /> CITY 71P PIIpNE Sf4�E LICENSE� <br /> M�CH�NICQCONTqACTOR M�I�ADURESS <br /> ��ry Z�� PHONE <br /> S��TF UCENSE r <br /> ' PWMBINGCONTpACTOR M�ILAOORESS <br /> ��TM I�P PHONE <br /> STAiE LICENSE• <br /> CONiRACi PqICE OF WpRK <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> OESCRIBE WORK�NU SOUARE F00T�6E INVOIVED <br /> CONTACT PENSON AND PHONE NO — <br /> ...�.'i fi�� <br /> I HEqEBY CERTIFV THAT I HAVE READ AND EXpMINED THIS <br /> PFOPOSEU USP OF BUIIDIN(3 APPUCATION AND KNOW THE SqME TO BE TRUE AN�CORRECT q�L <br /> PROVISIONS OF LAWS qND ORDINANCES GOVERNING THIS TYPE OF <br /> LEG�LDES—pFpp�pERTV�SHOWNBELOWpi�17/�M7WpCOME51 WORK WILL BE COMPLIED WITH WHETHcR SPECIPIED HEREIN OR <br /> �oT Bi�K oF NOT. THE GRANTING OF A PERMIT DOES NOi PqESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHEq STATt OR LOCAL LAW RE6ULATIN(3 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> A PL CAOONH�SP MADE ANO PERCOMP yHEW'HRKT ER S ATE <br /> FMCELLUlI.D.lNMBER t 4. � � �O� �a 9 O/Q CONTRACTORS LAW 1827 RCW AND 296200 WAC, <br /> J ! s /) <br /> CONSTR�TION IOAN lENOER.AppqESS.TELEPNpNE NUAIBER // / <br /> X V f� <br /> ' SIG4ATUpE <br /> DATE <br /> PLUMBING CITY BUSINE55 LICENS[NO <br /> NO. TYpE OF FlI(TURE OR�M MECHANICAL <br /> . FEE NO. TYPE OF EGUIPMENT <br /> � WATER ClOSET(TOILET) FEE <br /> BATHTUB � aC—AMNDLOUNfTS , <br /> LAVATORY(WqSH B,��N) ' FORCED AIR SYSTEMS , <br /> SHOWER ` ' HEAT PUMP � <br /> _ KITCHEN SINK 3 DISP . � UNIT HEATERS , � <br /> DISHWASHER ' CLOTHES DRVERS � <br /> � <br /> RANGEHOpD � <br /> LAUNORYTRqY � <br /> CLOTHES WASHER ' WATER HEqTER , <br /> � WOODSTOVE � <br /> URINAL , <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � � <br /> FLOOR DRAIN ' FIREPLACE INSERT(yy00D BURNING) � <br /> BACKFLOW PREVENTERS � �FIREP�ACE � <br /> � GASRANGE , <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING � <br /> � <br /> ' EXHAUSTFAN , <br /> � , <br /> � <br /> SUB TOTAL E ! � <br /> � SUB TOTAL S <br /> PEHMIT S � PERMIT s � <br /> TOTALFEE S � tOTALFEE S <br /> FOR OFFICE USE ONLY: � <br /> FRONTSF.Tp�CK REARSET&1CK SIOESEfB�CK <br /> PUNCNECKNUMBER iEE PECEIPTNO <br /> USE ZONF f 07 AFlE� VIIC�NT SITE <br /> FEES VAIUATION FEE <br /> ❑YES ❑ NO <br /> HEIGHi I.IMIi�TION NO.OF OWELLING BUII�ING i <br /> UNII$ SIIEOF6LOGR1 . <br /> PIUMNMC � <br /> i <br /> GROUP^NCY NO p[SlnqikS OCCUP�N7�04D B�SEMENI —}-- <br /> MFCHANICAL <br /> ❑YES ❑NO <br /> i <br /> FIRESPRINKI.EqqEO'D RFASON /DOIfIONRLPUNG��(.CN ' <br /> i <br /> FIREALARMREO'D HERSOV <br /> OINER --T— <br /> i <br /> SiRiE BUIIDING S11�CHAqGE <br /> TVPE OF CONST PL�qS nPPPOVEA BV -- � <br /> CITY OF EVERETT runi ir.wonHS — <br /> LOCAL SALES <br /> onrE TAX CODE IS 3105 70TAL —�-;—" � <br />