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APPLICATIO.J FOR CONSTRUCTeJN PERMIT � <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT;WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ,� BUILDING ❑ MECHANICAL ❑ PLUMIBING ❑ SU�N <br /> PROJECT ADDRESS: <br /> OIVlIER MNLI100PE55 p7y ZP PMONC -- <br /> l�i�Y`v,t/ ,C�,4�s�m b�9//J ��r/r+iv,-1„rr ia/ �✓tlt� 9�an3 �s 3 '3L79 <br /> TEN11 WUL�ODRESS GTY IIP VNpNE � <br /> CTOi1DE51GNER AWLADOnE55 CITY ZIP PHONE <br /> �f <Qr /�a�:�� �//:-�yA✓tSe-�✓��7} 9�yn7 33Y-G•/03 "leti �s�r 2 �G <br /> GENERµGONTRA�TOii _/ MIULADDRE55 GITY ZIP P110NE SGTEULENSE• <br /> MECHMIIC/�ICONTRACTOR MNLADDRE55 CITY ZIP VNONE STATEUCENSE� <br /> MbJBklC CONTR�CTOR M�ILADORESS �Itt IIP pHpNE STATE LICENSE� <br /> GONTMCT PRICE OF� . <br /> +'+ �, dU HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> OESGRME N'Oi1K ANU SWApE FOOTAGE INVOIVEU CONTIICT PENSON�ND PHONE NO <br /> r c� n-o �� As�{ �� 33 y-6/03 <br /> I HEREBY CERTIFY THAT 1 HAVE READ AND E%AMINEO THIS <br /> waroseouse eimarw APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �-rJ' �'�✓�C WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OH <br /> �°�°Eun°no�°FP"or�R^�(s�a�e��°w'°A�n'wHT'^°�Es� NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ioT�e�ocK 1ZJ�_oF 1G ft AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINO CANSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTFIORIZED BV THE <br /> OWNER OF THIS PROP[RTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> r�ncE�i�zio.��a CONTRACTORS LAW 1827 RCW AN 296.200 WAC. <br /> —�.`)�e' t�ia viv o0o x��/���.c.�.G;J' �f���� 9� <br /> CONSIIIUCM7N IO.W IENDER.�UGHESS.TELEP110NE NUMBER � ! <br /> SI�TU�E DATE � <br /> CITV BUSINE55 LICENSE NO. <br /> PLUNBINO MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILE� � NC—AMNDUi UNfTS � <br /> BATHTUB ; FORCED AIR SYSTEMS ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SH0IYER � UNIT HEATERS ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRVERS i <br /> �— <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER ; <br /> CLOTMES WASHER � WOODSTOVE —� <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) ' <br /> DRIYKING FOUNTAIN i FIREPIACE INSERT(WOOD BURNING) i <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GAS RANGE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> � FXHAUST FAN ' <br /> � � <br /> i <br /> i � <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S ; <br /> PERMIT S � PERMIT S � <br /> TOTALFEE S � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> if10HT SETBACK RE�R SEiBACK SIDE SETB�CI( PL�N CIIECK NUMBER fEF AECEIPT NO <br /> �Io10 <br /> USE 20NE l07�PEA V�CI1N�SIIE FEES VALUATION FEE <br /> ❑YES ❑ NO BU:LUING G�O �Qa �\� <br /> i <br /> HEIGHTLIMITATION NOOiDWEWNG SIZEOFBLDGRI i <br /> UNITS P�UMBING i <br /> OCCUPMICY fql%SI(%tlE5 OCCUPANTLO�O BASEMENT MECH�NIC�L � <br /> Gf10UP . <br /> ❑YES ❑NO � <br /> FlHESPRINNLERREO'D AEASIXJ �DDIfION�LPUNCN(.CR i <br /> OIHER � <br /> FlREAURMREO'D RE�CpN � / i <br /> STATEOUIlDIN65lIRCHnIiGE (� iVL.� <br /> -- r— <br /> TYPE OF f.ONST Pl�NS�PPROVED 0Y CITY OF EVERETT �1IB11f,W0fi85 <br /> LOCAL SALES ''— <br /> DAiE TAX CODE IS 3105 TOTAL c� � JJ <br />