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APPLICATII..�1 FOR CONSTRUCZ�ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-BB10 <br /> ❑ DEMOLITION ❑ COMBINATION � �BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PRWECT ADDRESS: � a / � ��` ��� �ti� ��n/ A //e � <br /> Jch .✓ I_ /�R iv�lY4 .c/-aexi�'y3 E,.N,� .y� ' ?sz-- 9 a �� <br /> OWHER MNL E55 CTy Zip pHpyE <br /> _l� Y�GNT <br /> TENNIT MNLI10DpE55 �ITY 21P p110NE <br /> �O.(/ � <br /> �RLMTECTOROESIGNER MIUlA00RE55 CITY ZIP PNONE <br /> 1�.ri��, aaP I�el�QiieSe2u� ro iSey��� FvP,�.�e� �i �zo3 337—S�2zz- <br /> GENERAI GONiR� OR Mlul ADDRE55 CITY IIP p110NE SGTE l ILFNSE� <br /> - �y C� /�I E� <br /> MELNIINICQCONTR�CTOq M�ILADDRE55 CITY ZIP PIIONE SUTELICENSE� <br /> No,v P <br /> PLUMBMGCONIRACTOR MAILADORESS Cltt ZIP PHONE STATELICENSE� <br /> CONTMCT�pF NpRI( <br /> �'3qpp �" HEATING SYSTEM: ❑4AS ❑ ELECTRIC 'J <br /> OESCRISE MIORN ANO SOUIIRE f�W7/KiE MVOlVEO CONTACT PERSON I1N0 PHONE N0. <br /> ia da� o /urdin C nre d - `/t- 2 �- <br /> s.sao Tv ,I�q/q w� <br /> I HEREBY CERTIFY THAT � HAVE READ AND E%AMINED THIS <br /> arroroseo use oF e�nianu APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> p WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEWLOESCRI TIONOFPROPERiY�SIpWNBEIpWpRARACHTWOCOPIES) NOT. THE GRANTINd OF A PERMIT DOES NOT PRESUME TO GIVE <br /> wr_ e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PqOVI510N OF ANY <br /> OTHEP.STATE OR LOCAL LAW qEGULATING CONSTRUCTION OR THE <br /> PEHFORMANCE OF CONSTRUCTION.THAT I AM AUTNORI2ED BY THE . <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MAOE AND I COMPLV WITH THE STATE <br /> PNiCELTA%I.D.MIMBER CONTRACTORS LAW iB27 RCW AND 296200 WAC. <br /> CANSiRIICTIONLW�NLEHDER.ADDRESS.TELEPIqNENUMBER x ' �i � i P � l 9Q6 <br /> SIGNATURE O�TE <br /> CITY BUSINESS tICENSE NO. <br /> PLUM81N6 MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEH CLOSET(TOILEn � A/C—lVHNDLG UNfTS ! <br /> BATHTUB ; FORCEDAIRSYSTEMS ' <br /> LAVATORY(WASH BASIN) � HEAT PUMP —;— <br /> SHOWER � UNIT HEATERS � <br /> K�TCHEN SINK 8 DISP ; CLOTHES DRYERS ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDHY TRAY ; WATER HEATER ' <br /> CIOTHES WASHER � WOOD STO'JE � <br /> URINAL � MEfAL FIREPIACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) i <br /> FLOOq DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GAS RANGE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> ' IXHAUST FAN ' <br /> � i <br /> � � <br /> i � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S ; <br /> PERMIT S i PERMIT S � <br /> TOTAIFEE S � TOTALFEE S ' <br /> FOq OFFICE USE ONLY: <br /> iRONT SETBACK RE�R SETB�CK SIDE SETB�CK PIAN CIIECN NUMBEA FEF fiECEIPT NO <br /> - 1 . . / <br /> USE20NE ior�ae� v�c�NrSttE � FEES A VALUATION FEE <br /> ❑VES ❑ NO OWIDMf. ��; ;. � T�J � �'�� <br /> � ✓.. <br /> NEIGHiLIMITATION NOOFOWELLING SIIEOFBLIXiRI � <br /> UN1T5 �LUMOING i <br /> � <br /> OCCUPANCY Iq(If51ptlF5 OCCUP�NTLOAD BASEMENT ' <br /> GRp�P MFCHANIC�L � <br /> ❑YES ❑ NO � <br /> FIRESPPINNLERflEO'� REASON ADDIIION�LPUNCMl:CR � <br /> i <br /> 0111EP � <br /> FIREAUfIMREO'D REACpN � <br /> S7AlE OUILOINC$UBCH�OGE � i •� � <br /> i �. <br /> _.' �_ <br /> TVPEOFf,pNSf OI�NS�PP(10VEDBY CITYOFEVERE7T ruenr.wonns <br /> LOCAL SALES — --'— <br /> o�TE TAX CODE IS 3105 TOTAL 1 <br />