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_-, _ <br /> APPLI�CATIOI_ FOR CONSTRUCTI� .� PERMIT <br /> CITY C�F EVERETT•BUILDING UIVISION <br /> 3200 CEDAR 5;::��1 • EVERETT, WA 98201 •259•8810 <br /> ❑ DEMOLITION ❑ CUMBINATION CI BUILDING MECHANICAL f] PLUMBING rl SIGN <br /> PROJECT ADORESS � � � C� -, <br /> �G�OI � V C�r .�4V . �✓ S'�o/ <br /> �T�J�'��S C%NiDitl l�, � _� � <br /> 21P PNOhE <br /> 7EWWT MNII�ODRE55 CITY ZIP PMONE <br /> AHGINTECTORDESIGNER MWIADIXiESS LITY 21P PMONE <br /> p�Nf fqNTp/�CiOp MAILADDNE55 CITY 21P PMONE ST�fEUCENSE/ <br /> /��`� Soue ,l��o��rs �s�� JU�,r-° .?>Q F�'�i`jr37o> ��3-Z>3( <br /> MECHANICALCONTMCTOH MNIADDRESS CITY ZIP PHONE S7ATELICENSEI <br /> L 1 — <br /> pWMBM/OCONTNACTOR MNLADDRESS Gtt ZIP PMONE ST�IEIICENSEI <br /> �°"T""°T �` DO HEATING SYSTEM: GAS O ELECTRIC f_7 <br /> 5[XJ <br /> pE5CIM7E Wqilfµp pWME FOOT/iGE WVOIVED / � GON7�CT PERSON AND PlIONE 1I0. . ���J �// .. <br /> G ,J/ <br /> / C' '�iv � � Z - E��in�� . <br /> ����r �/��� I HEREBY CERTIFY THAT I IiAVE READ AND EXAMINED THIS <br /> r� APPLICATION AND KNOW TNE SAME TO 8E TRUE AND CORRECT.ALl <br /> pnoroseo useoFe�aar+a �, ppOVISIONS OF LAWS AND ORDINANCES GOVERNING TNIS TYPE OF <br /> 1 ( � C WORK W�IL BE COMPLIED WITH WMETHER SPECIFIEO HEREIN OR <br /> �EWLLDESCPopT10NOFGROPERTY(SHOWNBELOWORATTACMTWOCOPiES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or a�oac �- oF AUTHORITY TO VIOLATE OR CANCEL TME PROVISION OF ANV <br /> OTHER STATE OR LOCAL LA'N REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOR�ZED BY THE <br /> OWNER OP THIS PROPER7Y TO PERFORM THE WORK FOR WMICH <br /> � ApPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 286200 WAC. <br /> PARCEL TA%I.D.NUMBER ' // !�� <br /> //�� � /� <br /> CONSTRlICT1IX/LOANIENDER.A001iE59.TELEPHONENUMBER v - 1��� Z <br /> 51 UPE O�TE <br /> CIIY BUSINE55 LILENSC NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF flXTURE OR 17EM FEE NO. TYP[OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILEn � A/C—AMNDLG UN�TS—H.P. ' <br /> BATHTUB ' FORCEDAIRSYSTEMS—B.T.U. E.A. ' <br /> UVATORY WASH BASIN) � HEAT PUAIP ' <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHF.S DRYERS � <br /> DISHWASHER � VENTII.ATION FAN ' <br /> i <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HcATER ' � <br /> URINAL ' WOOD STOVE � <br /> DRINKINO FOUNTAIN ' MFTAL FIREPLACE(WOOD BURNINv) � <br /> i <br /> FLWR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � _ <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE ' <br /> � <br /> � GAS PIPING _ <br /> , EXHAUSTFAN ' <br /> � � <br /> i � <br /> � <br /> � � <br /> SUBTOTAL S ' SUBTOTAL S � <br /> PERMIT S � PERMIT 5 � � <br /> TOTAL FEE S ' TOTAL FEE f '� <br /> FOR OFFICE USE ONLY: <br /> FHWIT SETBACN REM SET&�CK SIDE SETBACK PIAN GHECK NUMB)ER FEE RkCE1PT NQ <br /> G' l�/t tl� <br /> USEZONE LOT�NEA VACANTSITE <br /> FEES VALUATION FEE <br /> ❑YES ❑ NO BUIIDING � <br /> � <br /> HEIOMTLIMITATION N�NO�TS OWEWNO &ZEOFBLDCYLI. FLUMBINd � <br /> OCCUPANCY Iq.0i5TORiES OCCUPANTLOAO BASEMENt MECNAN�CAL � <br /> �ROUp � <br /> OYES ❑ NO � <br /> ADDITI, '_PLAN CMECK I <br /> FIREAWiMREO'D NEASON . i <br /> . � <br /> OTMER ' <br /> _.� <br /> FIPE SPPINKIER REO'D REASON STQF nG SURCHARGE � <br /> i <br /> TVPEOFCONSL PIANSAPPROVEDBY CITYOFEYERETT PUBLIC �KS ' <br /> LOCALSALES ; <br /> o�tE TAX CODE IS 3105 TOTAL <br />