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APPLICATIf„`�I FOR CONSTRUCY"flN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 T <br /> p' DEMOLITION p COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING p SiGN <br /> PpOJECT ADDRESS: ,�S'O`1 FUG Td,cJ Fut.1F� <br /> � <br /> FV£RfT1' 60.SPf� rn�ss�oel P 8ox .�I.a3 ��F,ze-rT 9gau1 07�.� ¢7�6 <br /> ONTIER MAlL�00RE55 CITV 21P PMONE <br /> VA C R rtJ'r <br /> � IEN�WT YMLI10W1E5S CITY 11P PNONE <br /> ARCHIiECT qi DESIGNER MAII ADORE55 CI7V ZIP PHpNE - <br /> �• CITY 6F FVERFTT FrRE '�FPAa'�'n�e �7T <br /> GENERALCONTHACTOiI . /JLADDpE55 �ITY pIP PIIONE SGTEUCENSE� <br /> MELHANICA�CpNTRACTOR MMADdiE55 CITY IIP PHONE ST�TEUCENSE� - <br /> PLUIIBING CONTPA�Tpq MAILADORESS f.ItY ZIP PHONE SiATE LICENSE� <br /> CONTMCT PRICE OF WJRN <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> DESCRIBE WOANAND SWARE FOO7/iCE INVOLVED CONTALT PERSONAND PNpNE NO. <br /> . 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> vnoroseo use oF euaona APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> IEGAlDESCRIPTIONOFPFqPERtt�SHOWNBELOWp1AiTACMTNYICOPIES) NOT. THE 6RANTING OF A PEHMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocK 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 BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM TTiE WORK FOR WHICH <br /> s/�.3� � G-�7 - G/3 —0000 APPLICATION IS MADE AND I COMPLY WITH THE STATE ' <br /> ru�ce�iroc i.o.r+uMeEn - CONTRACTORS LAW 18.27 RCW AND 296200 WAC. I <br /> ti ¢ <br /> . CONSTRUCTIONLOANLENDER.�DDRESS.TELEPHONENUMBER X_ �Q(/��M'` �), �/���q[t!� ��Z�,pG . <br /> SIGNATUNE D�TE <br /> CITY BUSINESS IICENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> 'NO. TYPE OF!'.XfURE OH ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILE� � A/C—A/HNDLd UNfTS � <br /> BATHTUB ; FORCEDAIRSYSTEMS ; <br /> UVATORY(WASH BASIN� � HEAT PUMP , <br /> SHOWER � UNIT HEATERS � <br /> KITCHEN SINK 3 DISP � CLOTHES DRYERS � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDqY TRAY ; WATER HEATEfl ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL � METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT(WOOD BURPIING) ; <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> � BACKFLOW PREVENTERS ; GAS RANGE ; <br /> SINK(SERVICE-BAR,ETCJ � GAS PIPING � <br /> � ' FXHAUST FAN � <br /> i � <br /> i � <br /> SUB TOTAL S ; SUB TOTAL S ; <br /> PERMIT S � PERMIT S � <br /> TOTAIFEE S � TOTALFEE 5 � <br /> FOR OFFICE USE ONIY: <br /> FRONT SETBACK RE�R SETBACK SIDE SETBFCR PLAN CIIECN NUMBER FEF RECEIPT HO <br /> 2 �.3 <br /> � USESOriE IOTARE� yACAN�5ITE FEES VALUA710N FEE <br /> . ❑YES ❑ NO OpIl01NG � <br /> i <br /> HEIGIITUMITATION NO OFDWELUNG SIZEOFBLOCRI � <br /> UNITC p���1,101NG i <br /> � OCCUPANLY Iq Oi5I0WE5 OCCUPANTLO�D B.�SEMENT T— <br /> GRWP MECNeNIC�I i <br /> ' . OYES ❑NO � <br /> � <br /> FIRESPRINK�EflflEO'D BEASON �DDIfION�LPUNC11f.C1c � <br /> i _ <br /> O1NEH � <br /> FIREAUNMREO'D RE�gpN � <br /> i <br /> $TAiE OUIIDING 511fIC11MfE � <br /> TYPEOff,ONST PLANSAPPOOVE�9Y � <br /> CITYOFEVERETT rur�,ir.wonns ' <br /> LOCAI SALES — —�— <br /> DATE TAX CODE IS 3105 TOTAL ; <br />