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APPLICATIvN �OR COIdSTRU�'� ION PERMIT <br /> CITY OF EVERETT•BUILDING DIVIGION <br /> 3200 CEDAR STREET• EVERETf, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �1 MECHANICAL � PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: _ I01V R /�-��I�Y1�'YL.�r'-� � <br /> OWNER MRILAOUPE55 Cltt Z��' P110NE <br /> i,���c� i>m �.-c/�i.�_ �'�Lor�.f� ��Yd�v/ �59-/3�/ <br /> TENANT MULA00RE55 CIIY l��' P1101.E <br /> ARCHITEGT OR OESIGNER MNI ADDRE55 ..ItY )In P�IONF. <br /> GENEMICONiMCTOR MAIL�DDPESS CIIY I�� ��IONE SfATEUCENSE� <br /> /� MECHANIC�LCOnNTRACfOR MAILADURE55 CITY n 71P � P��ONE $TATEULENSE• <br /> `R! Y//lll� lY /"'✓�/�rY//���� /Xl�/�/.V/��/� �L/� %l16LL/���L��/,�I"TtW�I��� <br /> PLIIMBINGCONTRACTOR MN�ADOFE55 GtY ZIP PHONE STATELICENSE� <br /> CONfR�CT PRICE OF WORI( <br /> HEATING SYSTcM: �GAS ❑ ELECTRIC ❑ <br /> OESCRIBE YIORN ANO SOUARE FOOT�GF INVOIV D � f.ONT�Ci Pf.R50N ANp PMONE N0 <br /> �„it,/fLi/ it/<w �/�',� � ; l�a_��r�G <br /> � ` /�/� / 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> /�lJ� /,Jr��i �� < ai� t' APPUCATION AND KNOW THE SAME TO BE TFUE AND CORRECT ALL <br /> PROPOSEDUSE OF BUILOING PROVISIONS OF LAWS AND ORDINANCES GOVERNING �HIS TYPE OF <br /> s`� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�LUESCRIPTIONOFPROPERtt�SHOWMBELOWORATfALN7WOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BIOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHC�RIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> PMCELTAX I.D.NUMBER <br /> CONSTRUCTION LOAN LENDER.AODPE55.TEIEPHONE NIIMBER x IQ <br /> SIfNATVPE D�TE <br /> /'�1�-7��D <br /> cin euswess ucer+se no � <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLG UNITS ' <br /> BATHTUB ; FORCED AIR SYSTEMS � <br /> LAVATORY(WASH BASIN) � HEAT PUMP ' <br /> SHOWER � UNIT HEATERS � <br /> KITCHEN SINK&DISP ; CLOTHES DRYERS � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE ' <br /> URINAL � METAL FIREPIACE(WOOD BURNING) � <br /> DHINKING FOUNTAIN ; FIAEPLACE INSERT(WOOD BURNING) � <br /> FLOOR ORAIN � GAS FIREPIACE � <br /> BACKFLOW PREVENTERS ; GAS RANGE � <br /> SINK(SERVICE—BAR,ETC.) G�S PIPING ' <br /> F�CHAUST FAN � <br /> � <br /> � <br /> � � <br /> -- --"--'— - — -- ' <br /> — — � <br /> ----r— <br /> � <br /> SUB TOTAL S ; SUB TOTAL 5 � - <br /> PERMIT S � PERMIT E � <br /> TOTAL FEE E � TOTAL FEE 3 - <br /> FOR OFPICE USE ONLY: <br /> FRONT SETBACN RERR SF.TBACN SIOE SETB�CN �UNCIIEC.N NUMfl[R fEF RFf.EIPT NO <br /> VACANI SIiE FEES VALUATICN FEE <br /> USEZONE LOT�REA � <br /> i <br /> ❑YES ❑ NO pinl01N6 � <br /> HEIGMT LIMITATION NO OF OWELLING SIZE OF BLDGRI ' <br /> UNIiS PLIIMOIN6 � <br /> i <br /> OCGUPANGY HO Of StORIES OCCUP�Ni LOAO e�$EMEN7 MECMANIC�I ' _ <br /> GROUP — <br /> ❑YE$ ❑ NO <br /> AOU1710NRI.�'1 AN GIIf.GN _ <br /> FIRESPRINKLEflREO'0 FEASON <br /> O���E� ' <br /> i <br /> FIREALARMREO'D fiEASON � <br /> S1AlE 11UI10�N.SUi1f.11n110E � <br /> 7YPE OF f.ONST �UNSPPPROVED F1Y CITY OF EVERETT PIIpI If.WA��NS <br /> LOCALSALES <br /> onre <br /> TAX CODE IS 3105 To7nL <br />