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APPLICATIOr. FOR CONSTRUCTIdN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-B810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: � � • a'�� - <br /> � 3 � <br /> 01NIER MA ADU11E S /� CITV ZI PHONE <br /> iEN/u1T �� ��/-,'tJ <br /> MNt E55 GITY IIV PNONE <br /> MCMTECTORDESIGNER MAllA00NE55 Cltt 71P PHONE <br /> OENEIWCONiMCTOR MNIADDRE55 C11Y -_ IIP PIIONE $qTEIIGENSE• <br /> ('nmol 10 �n�So,n uc o IS'�I l.)o �mnre �� SIQ���{�} Q`62o1 75�'a AI�'1 C�rnolr,so�L'D <br /> MECHAM CONTMCTOR MAIUDORE55 CITV ZIO PHONE S �TE UCENSE� <br /> PLUMlNM.CONTRACTOR MIIILAOORESS Clrv IIP PNONE STATELICENSE� <br /> CONiMCT PItlCE OF WORM <br /> HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br /> YN1pK 11ND SOUARE FOOTACiE INVOlVEO LONT�CT VERSON A!N PHONE NO. <br /> Z <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 /> vnoroseo use or einan+o PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHEF SPECIfIED HEREIN OR <br /> �ryuoescmv�oFpiareanlsxormee�owoa�rt�eHiwaeoviesl NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REOULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORRED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTA%I.D.MIYBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> . CONSTMICTION LOuI LENOER.ADORESS.TELEP110NE NUMBER x <br /> � 516N TUR OATE <br /> na(o-�c�� � <br /> CITY BUSINESS UCENSE NO. <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CIOSET(TOILE� � A/C—MiNDLa UNRS ' <br /> BATHTUB ; FORCED AIR SYSTEMS ; ' <br /> LAVATORY(WASH BASIN) � HE�T PUMP � <br /> SFIOWER ' UNIT HEATERS ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER ; � � <br /> CIOTHES WASHEH i WOOD STOVE � <br /> URINAL � MEI'AL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT(WOOD BURNINCa) i <br /> FLOOR DRAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS � GASRANGE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> � EXHAUSTFAN ' <br /> � � <br /> � ' <br /> SUB TOTAL S ' SUB TOTAL S i <br /> PERMIT f � PERMIT 5 � <br /> TOTALFEE S ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FNOHTSETB�CK REARSETB�CN SIDESETBACK Pl�NG11ECMNUMBEF FEF Aff.E1PTN0 <br /> _ss�9 <br /> USEZONE LOT�PE� �ACANTSIfE FEES VALUATION FEE <br /> � <br /> ❑YES ❑ NO OUIIDINC � <br /> MEIONTLIWT�TION NO.OFDWELLING SIZEOFBlD6/f.l � <br /> i <br /> UNq$ PlUM01NG � <br /> T <br /> OCCUPANCY NO Oi51MtlE5 OCCUPANfLO�D BASEMENT MECNSNIC�L � <br /> GROUP <br /> ❑YES ❑ ND <br /> FlRESPRINKLERREO'U REASON �ODIfIONALPUNCIIECN _ <br /> i <br /> OtIIEA � <br /> � <br /> FlNEAUIiMREO'D AE�SON � <br /> $TAIE BUIIOINO SURCH�f1GE � <br /> TYFEOFf.ONST PL�NSAPiROVEDBY CITYOFEVERETT CUAl1�WO�KS ' <br /> LOCAL SALES --�— <br /> OATE TAX CODE IS 3105 TOTAL � <br />