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APPLICATI(..J FOR CONSTRUC7 ..)N PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br /> -.PROJECT ADDRESS: <br /> � i;,..-�i �-,t �l ���n � I ��� Zl�l�i-�n��r.L-� ��P�-��' ��a�R' z���� 733� <br /> OWNER M�ILApOqE55 Cltt IIP PHONE <br /> TEN�NT IAAI�DDRE55 LITV lIG PIIpNE <br /> ARLNiTCCT OR OESiGNEB M�II AD�RE55 Cltt 71� PHONE <br /> GENERAI CONiflACiOR All ADDRE55 Cirv ZiP RIONE GtAiE llC[NSE� <br /> ��i ����,�p��f S�e�,:� PEs ��pJ ����i� ����.e cXl�l� G�5-5�1�1 EII�GyN�k1170� <br /> IA NA1TiCMCONTRnCTOR MAIIA��RE55 Cltt ZIP PIIONE STALEIICENSE� <br /> PWMBWGCONTR�CTOR EUILADDBE55 Litt IIV PNONE $T�iELICENSE� <br /> LONfRALT PFICE OF WORK <br /> � HEATING SYSTEM: �GAS ❑ ELECTNIC ❑ <br /> DESCRIBE WORK�ND SOUARE FOOT�GE INVOLVED CONT�LT PERSONAND PHONE NO <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROPOSED USE OF BUILOING PpOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIF�ED FiEREIN OR <br /> LEGALDESCRIPTIONOFPROPERN�SlIOWNBELOWORRTfACHTWOCOFiLS� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or eiocK ov AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LUCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPEflTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMGELTN:I D.NUMOcR CONTRACTORSLAW 1827 RCW AND 29§200 WAC. <br /> � /i <br /> CONSTflUCTIONLOANLENOER.AWJRE55.TELEPHONE N1IMBER /' �� / �z` � / <br /> x i"I :s.7J.�1r��1!•� / �-r�-�d <br /> SIGNATURE � � D�TE <br /> LIiV BUSINESS IICENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR�TEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS ' <br /> BATHTUB ; FORCED AIR SYSTEAIS ; <br /> —� <br /> LFVATORY(WASH BASIN) i HEATPUMP � <br /> SHOWER ' UNITHEATERS ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS i <br /> DISHWASHER � RANGE fi00D <br /> LAUNDRY TRAY � WATER HEATER ; <br /> CLOTHES WASHER WOOD STOVE � <br /> URINAL ' �dETAL FIREPLACE(WOOD BURNINv) ' <br /> DR�NKING FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) � <br /> _�— <br /> FLOOR DRAIN � GAS fIREPLACE ' <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING <br /> � EXHAUSTFAN <br /> i <br /> i <br /> i � <br /> SUB TOTAL $ ' SUB TOTAL S � <br /> PERMIT 5 � PERMIT S .J � <br /> TO7ALFEE S TOTALFEE $ <br /> FQR OFFICE USE ONLY: <br /> FRONT SETP�LK REAP SFTBRCK SIDE SETB�CN �UN C11ECN NUMB[II (EF fiFCFIPT NO <br /> USEZONE IOT�RE� V�GNISILE FEES VALUATION FEE <br /> i <br /> ❑YES ❑ NO ppitOlNG � <br /> 11EIGIrtLIA11TRION NOOFOWELLING 9.EOFBLD6Ri � <br /> UNI�S PIUMOMG � <br /> — � <br /> OCGUP�NCY NO 0�SIORiC`� OCCUPANi lOAp BRSEIAENT MECIIRNICRL � <br /> GPOUP <br /> ❑VES ❑NO <br /> FIRESPRINKLERREO'D Rf�50N ADDIIIONPLPIANC��fCN — <br /> ou�en <br /> FIPEAIARMREO'D �F�SON <br /> STAIE OUILDIHG SIIRCI�MCE <br /> fVPEOFf.ONST vinNserv�ovenev CITYOFEVERETT runur,wones <br /> LOCAL SALES ----- - --— ------ — <br /> oaiE TAX CODE IS 3105 ToipL _ <br />