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APPLICATIOrr FOR �ONSTFi�ICT1�aN �ERMIT <br /> CITY OF EVERETT• BUlLDING DI'✓ISION � <br /> 3200 CEDAR STREEf• EVERETT, WA 98201 4 (425)257-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MEGHANICAL ❑ PLUMBING � SIGN <br /> �n PR��/OJECTADDRESS:� IOo�� AJp Fr�e.w�I" L�� l�c� � <br /> �l.a�r�n�LL�Mrf�cr� � <br /> OWN.q MULA�DFE55 Cltt IiP CNONE <br /> TENANT MAII��ORE55 dTY ZIP PUONE <br /> �RCNRF.CTOR�ES�GNE� M�ILAD�RESS GIIY ZIP PNON[ <br /> GF.NERAIGONiPACTOR MAiLADpFE55 GIiY IiP Pn04E aSa -���IAfE LICFNSE� <br /> ,�-11 T,��,�.–_ �oa� �.�t ll�e �,no,-�—�,1R- 9�at�l c�das`^,�-.=':l ��.�, <br /> EGHANICAL rn ,��� MAILADDRE55 CITY ZIP PIIONE STATF.UCENSE� <br /> �r-��."DA� <br /> � PIUMBINGCONiRaf,TOR /ILADDqE55 GITY 21P PHONE $TATELICENSE� <br /> C NiR�CT F ICE OF WORR <br /> HEATING SYSTEM: ❑ GAS ❑ EIECTRIC ❑ <br /> UESCR E WORN ANO:OU�RE FOOTAGE INVONED CONTACT PEf150N�ND PHONE NO <br /> � �� 0,:,.Q ,.Y,�Q�d � �� ' l � asa->27� W�6-�,41, <br /> c���; ��m w a5 7 -�6`!Y <br /> /,� �� �`Q I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> K APPUCATION AND KNOW THE SAME l'O BE TRUE AND CORRECT ALL <br /> PR POSEU USE OF 9UIl01NG PROVISIONS OF LAWS AND ORDINANCES GOVERNING THI3�fYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEWLOESCRIPTIDNOFFROPEiiTY�SHOWNBELOWORATfRLHiWOLOPIE51 NOT. THE GRAWTING OF 4 PERMIT DOES NOT PRESUME TO GIVE <br /> �oT_ e�acK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REGULAiING CONSTRUCTION OR THE <br /> PEiiFORMANCE Of CONSTRUCTION,THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOAK FOR WHICH <br /> APPIICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%ID.NOM�EB CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> / <br /> CONSTRUCTION LOAN LENDER.�ODFE55.TELEPNONE NUMPER X oZ <br /> SIGN�UR D E <br /> CITY BUSINES$LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILE� � A/C—A/HNDLG UNITS ' <br /> BATHTUB ; FORCED AIR SYSTEMS ; <br /> LAVATORY(WASH BASIN) i HEAT PUMP � <br /> SHOWER ' UNITHEATERS ' <br /> � KITCHEN SINK 8 DISP � � CLOTHES DRVERS � � <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER ; <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) i <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GAS RANGE � . <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING � <br /> � EXHAUST FAN ; <br /> _ � <br /> i <br /> i � <br /> SUB TOTAL $ ; SUB TOTAL 8 ; <br /> PERMIT S i PERMIT $ � <br /> TOTAI.FEE 5 ' TOTAI FEE $ V ' <br /> �OR OFFICE USE ONLY: <br /> FRONTSFTO/C�' FF.MSETBRCK SIpESEiB�CN �UNGIIEGBNUMP[R /� / �fE �ff.FIPTNO <br /> S <br /> lISE ZONF I Oi AREA VACRNI SIiE FEES VALUATION FEE <br /> T <br /> ❑YES ❑ NO ppllf]Mf. <br /> FFIGNI UMITATIJN NO GF OWELLING 512E OF BLOGRI <br /> �����5 PWM9MG <br /> — T <br /> OCCl1PRNCY NO 0�SlpniES OCCUPANI LOAD 6ASEMENf MFf.MI.NiCAI <br /> GROUP _ — -- <br /> ❑VES ❑NO <br /> FIRESPFINKLERREQ'0 �FIISON �DDi110NnLPUNG�f.CN � <br /> �__ <br /> on�en ; <br /> FIPEAIARMRE4D AFASOV <br /> $iAIE OUIlOiNG SIIf1C11nOGE <br /> ivve or r.a�sr r�nNs nrvaoven ev CITY OF EVERETT P11911f.WORKS ; <br /> LOCALSALES — '— —y-- <br /> oATE TAX CODE IS 3105 TOTAL <br />