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APPLICATIO. : FOR CONSTRUCTI JN PERMIT <br /> CITY OF EVERETT•BUILDING OIVISION <br /> 3200 CEDAR STREET•EVERE'f?. WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECMANICAL ❑ PLUMBING ❑ SIGN <br /> PRWECTADDRESS: ?�22 �,`'t'iT 1//£tJ t�J.�'i�/£ E�: <br /> f�.�' Gi_ /=. ..S�AyJLiP JQ. 2l2Z .�a.^c.r> viC•:�,�'•f. 98Ze3 353- l0(/9 <br /> 01MNER M�1ILAOORE55 LITY II� PNONE <br /> TEN�NT MNU00l1E55 f.ITY 71P pMpHE <br /> ARC/MTECT Oi10E51GNER M�IL ADDRE55 CITY IIP PNpNE <br /> 6ENEMLCONTRAGTIXI MIJLAUDRESS CIIY Jm Pi1pNE SIATEUCENSE� <br /> C G -Z <br /> MECHIINIC�ICONTRACTOR MAIl�Od7E55 CITV IIC PIIONE STATEUCENSE� <br /> PLUYBINGCONTRFC7:W Y�ILAWHE55 CIIY jIP PNpNE STATELICENSE� <br /> CONiMGT PRICE OF VNr�K <br /> 2c�/GZ Bo HEATINGSYSTEM: [,$GAS � ELECTRIC ❑ <br /> OESCRIlE W�7fIK�ND SIXIARE FOOTA6E WVOIVED GONT�GT VERSON NID PNONE Np <br /> .d✓ + .VO Lc/9 ' <br /> Pc�c ,-- <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 /> PIqPOSED USE OF WRpNO PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEMLOESCPoPTIONOFPi10PERTY1�roWNBElOWp1�R/�LMTNqCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior aiocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> • APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL Tl1%LD.NUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> WNSTqUCT10NLOMLENDER.AWRE55.TEtEP110NENUMBER �N� _ �QE�(p"5'G <br /> CITY BI151NE55 LICENSE NO <br /> PLUMBINO MECFiANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EGUIPMENT FEE <br /> WATER CLOSET(TOILEn � NC—AhiNDL6 UNfTS ' <br /> BATHTUB ; / FORCED AIH SYSTEMS ; <br /> UVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS ' <br /> KITCHEN SINK 6 DISP ; CLOTHES�RVERS � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER ; <br /> CIOTHES WASHER � WOOD STOVE � <br /> URINAL ' MEfAL FIREPIACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN ; FIREPLACE INSEFiT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; GASRANGE ; <br /> SINK(SERVICE—BAR,ETC.) � 2 GAS PIPING � <br /> EXHAUSTFAN ' <br /> i � <br /> 1 � <br /> SU8 TOTAL S ; SUB TOTAL S ;0� <br /> PERMIT S PERMIT S �QD <br /> TOTAL FEE S ' TOTAL FEE S 'p0 <br /> FOH OFflCE USE ONLY: <br /> ifqHT SETBACK PE11R SETB�CK SIOE SETB�CN Pt�N CIIECN NUMBER FEE REf.E1PT NO <br /> � � <br /> USE20NE �OT�RE� VALIINTSI�E FEES VALUATION FEE <br /> OYES ❑ NO OUIlOING <br /> i <br /> NEIGNTLIWUTION NOOFDWEWNG SI2EOFBLOGR.1 <br /> UNIT$ Pl11MBING � <br /> OCCUPMlCY NO(%SIMES OCCUP�NT lOAO B/�SEMENT � <br /> �� MFCBeNICAL � <br /> OYES ❑ NO — � <br /> � <br /> FlBESP{IINKIERRE�'D AEASON ADW710Nq PUNC��F.LN <br /> � <br /> OTNER <br /> FIPEAURMREO'D REASON � <br /> STAIE OUIlDIN6 SIIpGR�pCE <br /> rraeovr,or�sr PlANS�PCPOVEOBY CITYOFEVERETT runnr.wonKs <br /> LOCAL SALES —y— <br /> DATE TAX CODE IS 3105 TOTAL � <br />