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� <br /> APPLICa►Tl�ih FOR CONSTRUCTIt+N PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION O COMBINATION ❑ BUILDING MECHANICAL ❑ PLUMBING f7 SIGN <br /> PROJECT ADDRESS �yGs �v�� A�� . <br /> OVRlER MNLADDilESS LITY ZIP PHONE <br /> ��,���� �/���kiG� ?ya5 Fv����-n' �rr� �v��T �Jg�i �SS - ys2� <br /> 7ENANT AWLADOAE55 CITY 21P PMONE <br /> MCHITECTORDESIGNEfl MIVI�DDRE>5 CITV 21P PHONE <br /> GE�EMLCONTMCTIXi MIULA0DRE55 CIIY 21P PHONE SUTELICENSE� <br /> MECH/�N�CALCONTRACTOR MIVLADDRE55 CIiY 21P PHONE ST�TEUCENSE� � � <br /> p�U1ABl�ONTRACTOR MAILAOORE55 Cltt ZIP PMONE ST�TEIICENSE� <br /> T��n"�-'� HEATING SYSTEM: f�GAS ❑ELECTRIC ❑ <br /> pE$CRI�E NqRK NID SOUARE FOOTAOE IHVOLVED / CONTACT PEPSON AND PMONE NO. ���� ��� _�//�/ <br /> Ll— �. G/C/FtiJ7� /�TG' L y <br /> �s N� � ��c�N <br /> �.N� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> vHoro io use oc eui�no r PROVISIUNS OF LAWS AND ORDINANCES GOVERNINO THIS 7YPE OF <br /> � nJT1/�"� — S 1 � WORK WILL BE COMPLIED WITH WHETHEH SPECIPIED HEREIN OR <br /> �cuuoEsc�nvnpaoFv�aaennis�+ovmee�owoa�n�cnnwcoaies� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> iot Bi�K • � � AUTHORITY TO VIOLATE OR CANCEL TME PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTIJN OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY TiE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 298200 WAC. <br /> PMCEL 7/Jf I.D.MMBEN �- / y <br /> CONSTRUCTON LOIW LENOEP.�Od1E89,iELEPHONE NUAIBER (�--- /l ( Z�-/S <br /> 6pN�, RE O�TE <br /> CITV BUSINE55 U:ENSE NO. . <br /> PLUMBIN6 MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM FEE NO. TYPE CF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILE� � A/C—lNiNDLG UNITS—H.P. ' <br /> ���8 � FORCED AIR SYSTEMS—B.T.U. S � <br /> LAVATORY(WASH BASIN) � HcAT PUMP ' <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 3 OISP i CLOTNES DRYERS T <br /> DISHWASMER � VENTILATION FAN <br /> LAUNDRY TRAV ; RANGE HOOC � <br /> CLOTHES WASHER � � WATER HEATER ' <br /> URINAL ' WOOD STOVE � <br /> DRINKINO FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> � FIREPLACE INSERT(WOOD BURNING) ' <br /> FLOOR DRAIN � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � , <br /> SINK(SERVICE—BAR,ETC.) � 6AS RANGE ' <br /> � OAS PIPING � <br /> , EXHAUST FAN ' <br /> � � <br /> i <br /> � i <br /> i <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S ; 00 <br /> PERMIT S � PERMIT S � <br /> TOTAL FEE S ' TOTAL FEE S '0� <br /> FOR OFFICE USE ONLY: ��7/ / <br /> FqpNTSETg�G( pEMSETB�CN SIDESETBACK PIANCHECKNUMBER FEE <br /> RECEIPT NO. <br /> FEES VALUATION FEE <br /> USEZONE LOT�REA VACANTSITE � <br /> ❑VES � � BUIID�NO � <br /> i <br /> MEIGHTUMITATON NOOFDWELUNO SiZEOFBLDCalTL � <br /> UNITS PWMBINO <br /> OCCUPANCY NO.OiSTONFS OCCUPMITLOM BASEMENT MECH�NICAL I <br /> GROUP —. � <br /> ❑YES ❑ NO � <br /> �Ul`��-0NALI� ��CK � <br /> FIREAIMMREOD REASON _ � <br /> . � <br /> OTH[R � <br /> i <br /> FIRE SPRINI(lER REO'D RE�SON i <br /> STATE BUILC -nCHARGE � <br /> TYPE OF CONST. PUNS MPROVEO BY CITY OF EVERETT PUBUC W01. � <br /> LOCAL::ALES � <br /> DATE TAX CODE IS 3105 TOTAL ' <br />