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^. , <br /> APPLICATIOr� FOR CONSTRUCTION PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT; WA 98201 • (425) 257-8810 <br /> ❑ DEMOLITION ❑ COMBIMATIO ❑ BUILDING �MECHANICA� ❑ PLUMBING ❑ SIGN <br /> PROJ CTADDRES : �g0� ��y�L{- ��JC -�Uc7LCr7 <br /> rl�� ,�/CQ-,cJ y8"oqc�/ua.s�c_-.t,u, �u��tc--I�� c�n9, 5�"Ze/ �Cr'-/-oozc� <br /> owr+ n � M�IUDOP�55 tin nr vHon6 <br /> --.V6�(Jf= <br /> iEN�NT YAII ADDRESS CITY 21P P1/0NE <br /> FRCNIT(CT OR DESIGNER M�IL A0I)FE55 Wtt TIP PHON[ <br /> GF.NFfiAL/C�ONTOACTOR MMLFDD�E55 CIIY IIP PHONE GIAiE IICENSE• <br /> MECNANICA��p�ACTOR MAI�AD�RE55 CIiY 21P PIIONE STATF.II�ENSE� <br /> PWMBINGCON7RAf,TOR M�IL�DDRESS LITY ZIP PHONE $TATFLICENSE� <br /> c��CTPRICEpF= HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> m� <br /> DESCRiBEWORKAND5011�REFOOT�pE oW,E^O'� � CONTACTVENSON�NpP;ip!¢NO <br /> N� � ���/�-.c � <br /> � � .v+f C- f � � /l!� 2 . <br /> �/ /' I HEREBY CERTIFY THAT I NAVE READ AND EXAMINED THIS <br /> � APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PF;1PpSED USE OF BUILOING PROVISIONS OF LAWS AND OPDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIEO WITH WHETHER SPECIFIED HERE�N OR <br /> LEGAlOkSCRIPTIIXJOFPROPERTY�SNOWNBEIOWORATThCH1WOCOPIE51 NOT. THE GRAHTING OF A PERMIT OOES NOT hAESUME TO GIVE <br /> ior _eixK or AUTHORITY TO VIOiATE OR CANCEL THE PROVI510N OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OP.THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> — OWNER OF THIS PROPERTY TO PERFOFM1I THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCEL TA%I D.NUMBER -- CONTR 1 ORS LA 27 CW AN�296200 WAC. <br /> CONSTRUCTION IOAN LENDER.A00qE55,iELEPHONE NUMBER ��"z�s� <br /> �TVRE D IE <br /> CITv 6USINE55 UCENSC Np <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FU(TURE OR ITEM FEE NO. TYPE OF EGUIPMENT FEE <br /> WATER CLOSET(TOILEn � A/C—NHN�LG UNfTS ' <br /> BATHTUB ; FORCED AIR SYSTEMS ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNIT HEATERS ' <br /> KITCHEN SINK 6 DISP i CLOTHES DRVERS i <br /> DISHWASHER � RANGEHOOD <br /> LAUNDRY TRAY ; WATER HEATEii � <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL � METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN i FIREPLACE INSERT(VJOOD BURNING) i <br /> FLOOR�RAIN � GAS FIFEPLACE ' <br /> BACKFLOW PREVENTERS � GAS RANGE � <br /> SINK (SERVICE—BAR,ETC.) GAS PIPING � <br /> � EXHAUSTFAN <br /> i <br /> � <br /> i ' <br /> � ; <br /> � <br /> SUB TOTAL S ' SU8 TOTAI 5 C/V ; <br /> � , <br /> PERMIT S � PERMIT E / � <br /> TOTAL FEE S ' TOTAL FEE S 7S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSFTfl�CK REARSF.TB�CK SIDESEfB�CN PUNLI1ELNf.'pMfl� �EF �ECF��TNO <br /> Sii�o <br /> usE zoNF 101�REA ��CANf SITE FEES VALUATION FEE <br /> —— ---r-- <br /> ❑YE� ❑ NU AUIL�MG <br /> i <br /> IIEIGNi I IMITATION NO OF DWELLING 512E Q�OLOC I I <br /> UNII$ PlUMO�NG � <br /> — —T <br /> OGCUPANCY NO 0�5���'k5 O(:CUP�NIIO�D BASEMENI NFCM4NIGl � <br /> f.ROVP - -- <br /> ❑YES ❑ ND � <br /> i <br /> FIfiESPRINKLERREO'� �F�SON AU�IIIONAI.PIANCHl.LM i <br /> —�_ <br /> i <br /> ot��en � <br /> PIRLAUf1MHE0'0 AFI.SQV � <br /> SUIClfUIl01NG SIIRCIIRIi6E � <br /> '_'� �— <br /> tvvenrr,o�+sr rinNsnrraovEnov CITYOFEVERETT ruflii�w���Kc ' <br /> LOCAL SALES -- — ---�-- <br /> onra TAX CODE IS 3105 TOTAL <br />