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APP�.IC,ATION FOR CONST�UC'�IQN PfRMIT <br /> CITY OF EVERETT•BUILDING DIVISIC � <br /> :t20��:EDAR STREET• EVERETT, WA 96201 •259-8810 <br /> l� UEMOLITION ❑ COMBINATIOFJ ❑ BUILDIMG ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS: ����,D �� LOr/ 3f?�'C7 �G� <br /> � 71�''9 f1- ���C� i3l�C"v— N����^`c'r /t'��o� CJQ- g�6S2 SS�—�7795� <br /> ER MMLApDf1E55 CITY ZIP VIIONE <br /> /(j/�C�� l <br /> .7 `� <br /> TENNIT MNLAODRE55 CITY IIP i'MONE <br /> �-/�- .' -�'-_� .2�v - k/�a�nr�' 98�2�/ zo�-�rf -,PJ3s <br /> ARCMITECTORDC51 NeR uui�noness an nr m�or+e �&7/ySJ <br /> _Z5[/J�7 //Dr/� �rRi�•^� ��b'37— �5� ,QJlr �11� �o�i.�diCL�' ista,dff7o6/�Z <br /> GENER�LWNTPACTOq M�ILAOORESS ❑IY Ti� PIIONE SGTEIICENSE� <br /> � <br /> MECHANICAL�TOR MAII ADDRE55 CITY Z�p PIIONE ST�TE LICENSE/ <br /> PLUYBWGCONTR�CTOp Me1LA�ppESS :,Itt IIP PHONE <br /> STATE UCENSE� <br /> � <br /> C(NIfMCi PRICE OF WOpN <br /> �aD�O HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> DESLRIBEWiMK�NO50UAREFOp7AGEINVOWED � CONT�CTPERSONAN�PNONENO <br /> /� sr-� �vnic - ��-- G� - <br /> r�ic�(,�; t'�._. � �u�t. <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ANPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT ALL <br /> FAOPOSEDIISE OF BIIILDIN(I PROVISIONS OF LAWS AND ORDINANCES GG`IERNING THIS TYPE OF <br /> WORf( WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCR4PTIONOFPROPERry�SHOWNBELOWOf1ATfACH7WOCOPIES) NOT. THE GRAN7ING OF A FERMIT DOES NOT PRESUME TO GIVE <br /> ioT BLOCK_ OF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> / O7HER STATE OR LOCAL LAW RECULATING CONSTRUCTION OR THE <br /> � �iN � PERFORVNANCE OF CONSTRUC710N.THAT I AM AUTHORIZED BY THE <br /> OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> AP?LICATION IS MAOE AND I COMPLY WITH THE STATE <br /> vu�ce T NUMBER CONTRACTORS,IAW 1827 HCW ApD 296.200 WAC. <br /> �3�� 33� oaa- oiv� � � <br /> STRUCTION LON1 LEN�ER.ADpRESS.TELEP/IONE NUMBER / '�'f/ ���� � y� <br /> _ iNA(URE OATE <br /> CITY BUSINESS UCENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF ECUIPMENT FEE <br /> WATER CLOSET(TOILEn ' A/C—AMNDLG UNITS � <br /> BA?HTUB ' FORCED AIR SYSTEMS ' <br /> � , <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNIT f1EATEfiS � <br /> KITCHEN SINK 8 DISP ; CL0711E5 DRYERS ; <br /> DISHWASHER —r R4YJGE HOOD � <br /> �— <br /> LAUNDRY TRAY ; WATER HEATEH ' <br /> � <br /> CLOTHES WASHER i WOODSTOVE � <br /> URINAL � METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) i <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> DACKFLOY. PREVENTERS � GASRANGE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPIN6 � <br /> ' EXHAUSTFAN ' <br /> � � <br /> i <br /> i i <br /> � i <br /> � � <br /> SUB TOTAL f ; SUB TOTAL S ; <br /> PERMIT S � PERMIT S � <br /> T�fAI FEE $ � TOTAL FEE S �_ <br /> FOR QFFICE USE OPILY: <br /> � FRONT SETflACN REAR SF.TBACK SIUE SETBeCN PLAN C11Ff.N NUMO[R P[f f1Ef.FIPT NO <br /> =sc�� <br /> usezonE IOT�REA VAC�Ni51IE FEES VALUATION FEE <br /> ❑YES ❑ No ounnu+c /5� � � <br /> NEIGIIT LIMIT�TION NO Oi DWEtLING SIZE OF BIUGRI i <br /> UN175 PlUM01HO i <br /> — _ _ { _ <br /> GC�PANCY NOOi51puE5 OCCUPANIIO�D BASEMENt MECIInNICnI � <br /> ❑YES ❑NO -- — ' — <br /> FIRESPflINKLERflEO'D REASON /•OUIIIONaI.PIANCIICGN � <br /> i <br /> _i___ <br /> OtuEn <br /> FIREALAFiMHEO'D HE�C(NI <br /> i <br /> . STAIGBUIlD11lGSIIRCIURGE --' P� <br /> TYPEOFf,ONST Pl�NS�PPROVEDOV CITVOFEVERETT PIIf1UCWOnKS <br /> LOCAL SALES --- --'— <br /> ORiE TAX CODE IS 3105 T0T4L U � <br /> • y - <br />