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��1 <br /> APPLICATIL�a FOR CONSTRUCT .�N PERMIT <br /> CITY OF EVERETT• BUILDING OIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINpTION ❑ BUILDI/h1 �u'/ �MECHANICAL ❑ PLUMBING (] SIGN <br /> PROJECT ADDRESS: �/> �z� �,QM A le I� fiV �`I� - ' ��-C� <br /> OWNER M�ILAOORE55 Cltt 21P PNONE <br /> D��\, �, �u�E�cc� lR � z CvMt���� /��( c=��—�fi �l�a�a � z>q -�-l�� <br /> TENANT � M�ILAUDPC55 CITY LP FHONE ��— <br /> / <br /> :L�/ <br /> ARCHITECT OR DESIGhER MAII�DORE55 (:Itt 7i� PNONE <br /> -9 ENE �l CONi �GIOq M�IL ADDRE55 C tY ZIP PHONE SInTE IICENSE� <br /> I�In�I��a�-�.e �T��z 7 Aon �.�n�kc �C,r�, �,l�t ��/�9 zSz���nn � <br /> MECHANICALCONTRRCTOR MNLAD�RE55 CITY � IION�{ E-- $TATELICENSE� <br /> (�0 r� T,1� ln� N I�;��� <br /> PLUMBING CONTNACTOR MnIL ADDRE55 Cltt ZIP PHONE STATE UGENSE� <br /> CONTRALT PRICE OF WORK <br /> ���D HEATING SYSTEM: ,�GAS � ELECTRIC ❑ <br /> UESCRIBE WOPKAND SOUAAE FOOTAGE INVOIVE� CONTAGT P[RSON AND PNONE NO <br /> � �� � <br /> I HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PqpPO5E0 USE OF BUILDING APPLICA710N AND KNOW THE SAME TO BE TRUE AND CORREC7 ALL <br /> PqOVISIONS OF lAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPIIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�LDESCflIPT10NOFPROPER7V�5HOWNBELOWORARACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT e�ocK oF AUTHORITY TO VI�JLATE OR CANCEL THE PROV;SION OF ANY <br /> OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THI RTY PERFORM THE WOtiK FOR WHICH <br /> APPLICATIO IS MA N COMPLY WITH THE STATE <br /> PAqCELTA%I.D.NUMBER CONTRA ORS LAW AN 296200 WAC. <br /> CONSTflUCT10N LOAN tEN�ER.AODRESS.TELEPNONE NUMBER � � x L V <br /> SIGN�TUR DA <br /> CITY BUSINESS LICENS[NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNRS ' <br /> BATHTUB ; FORCED AIR SYSTEMS ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP —r— <br /> SHOWER ' UNITHEATERS ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS i <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY � WATER HEATER ; <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL ' MEfAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GASRANGE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> ' EXHAUSTFAN <br /> � � <br /> � _;_ <br /> � ' <br /> SUB TOTAL E � SUB TOTAL $ / � <br /> PERMIT $ � PERMIT E �.� � <br /> TOTAL FEE 3 ' TOTAL FEE $ �� ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACN REARSF.TB�CK SIpESETBACN PL�HCIIECNNUMflEP FEF PEf.EIPTNO <br /> �3/�a- <br /> usEZone iounEn vncerursre FEES VALUATION FEE <br /> ❑res ❑No owinwc � <br /> _ I <br /> MEIGHT LIMITATION NO OF DWELLING SIZE OF BLDGR.I � <br /> UNIfS PLUMOING ` <br /> OCCUPANCY NO OiSI0NE5 OCCUPANTLOAO BASEMENT MEC11aNICAI � <br /> GROUP � <br /> ❑YES ❑NO — <br /> FIRESPPINKLERREO'D �7EASON /OUIilONA1.PLANC11fGM _ <br /> on�En <br /> FIREAIARMREOD AEFCON � <br /> S1AYE OUIIDING SIIfiClUfIGE � <br /> -- r— <br /> !YPEOFf,ONST PlANSRPPROVE�BY CITY OF EVERETT ruour.wonKs � <br /> LOCAL SALES — <br /> onre TAX CODE IS 3105 7oTAL <br />