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APPLICATII.N FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ,�MECHAFJICAL ❑ PLUMBING ❑ SI(iN <br /> PROJECT ADDRESS: <br /> ���.�onl 1���� �s �Zo� �J �m � �l ��iJ��2� �ao� �i- d��� <br /> ���� MMLI100RE55 CITV 21P PHONE <br /> �A N�� <br /> iEIUNT 4M�OIXiE55 CITY IIV P110NE <br /> �W.:MTECTOIIDESIGNEiI MMI�DpRE55 CITY IIP PMONE <br /> ��aL�lazE� I�{F��E� �A� o��t� S� �a�i� �s�z��o r�la�ltl�JE4-�o�,-���k <br /> GENER/1LCONTR�GTdi M/JL/�UDqE55 GTY )IP <br /> �ft(�'�� a� ���c:��� <br /> MECHANICALCONTR�CTOR M/u1�00HE55 � � CITY IIP PNONE :T�TELICENSE� <br /> � Arn� <br /> PLUMBMGCONTRACTOR M�ILAOORESS � CIIY ZIP P110NE STATEIICENSE� <br /> conrw�cTva�ocwonK � � HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> d <br /> OESCIMlE WOpI(�NO Sq1ARE FOOTAGE MlVOLVED CONT�CT PERSON I1ND PNONE NO <br /> i <br /> � " C � z 5�' �� `f� � <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> vnaroseo use oc e�mprro APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> WORK Wlll BE COMPLIED WITH WHETHER SPEi,IFIED HEREIN OR <br /> LEWLOESCIpPT10NOFP110PERTY(5lIOWNBELOWORATTACHTWpCOP1ES) NOT. THE 6RANTING OF A PERMIT DOES NOT PAESUME TO GIVE <br /> ioT e�ocu oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHEfl STATE OR LOCAL LAW REGULATINCi CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO P RM THE WORK FOR WHICH <br /> APPLICATIUN IS MA I OMP WITH THE STATE <br /> p,w��T�z i.o.M»�p CONTRACTORS LA 8 �B . 00 WA,. <br /> C7l/SIIIL'CTpiLOANIENDEN.ADdiESS.TELEPHONENINAEER O X �9� <br /> SIGN�TURE �TE <br /> CITY BU9NE55 LICENSE NO. <br /> PLUNBIN6 MECHANICAL <br /> N0. TYPE OF FlIRURE OR ITEM FEE NO. SVPE OF EOUIPMENT PEE <br /> WATER CLOSET(TOILEn � A!C—AMNDL�UNfTS � <br /> BATHTUB ; FORCEDAIRSYSTEMS ; <br /> LAVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS � <br /> KITCHEN SINK d DISP ; CLOIi!ES DRYERS i <br /> DISHWASHEH � RANGEHOOD � <br /> UUNDRY TRAY ; WATER HEATi:R ; <br /> CLOTHES WASHER � WOODSTOVE � <br /> _ , <br /> URINAL ' MEfAL FIREPIACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) i <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GASRANGE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> IXHAUST FAN ' <br /> � <br /> e � <br /> i � <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL f ; <br /> PERMIT S i PERMIT S � <br /> TOTALFEE S ' 70TALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FROHTSE78�CK RE�RSETB�GK SIDESETB�CN �UNCRECKNUMPEfi fEF �Ef.E1PTN0 <br /> USE ZONE l0T�REA V�C�NT SITE FEES VALUATION FEE <br /> �— <br /> ❑YES ❑NO OUILOIN6 � <br /> MEIGNT LIMITATION NO O�OWEILING SRE O�BL06RI i <br /> UNITS PlUM01NG i <br /> � <br /> OCCUP�NCY `q�i SIOPofS OfCI^PA LO�D B�SEMENT MECN�NICAL � <br /> GRIX1P � <br /> ❑YES ❑NO <br /> FlflESPRINKLEflREO'D RF.ASON ADDIiION�LPLANCUECN � <br /> � _ <br /> O7HEf1 � <br /> � <br /> FIREMARMREO'D RE�iON � <br /> S7�lE 8111101NC SIIRQufIGE i <br /> _" �_ <br /> trvear.or+sr rinNserrnoveoer CITYOFEVERETT runnr.wonKs <br /> LOCAL SALES — —''-- <br /> o�iE TAX CODE IS 3105 TOTAL � <br />