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APPLICATIC .1 FOR CONSTRUC7^JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUM8ING ❑ SIGN <br /> PROJECT ADDRESS: <br /> p Mu��ooness <br /> ��ry ..y�—ZiP�+�'7 PNONE <br /> TEN�!lTOW f\�P� 3���a �-I�21� l!`./�!'-Lil L/'ZlJ3 Z 1/� � � 7� <br /> ��C� MNLADpRe55 CITY ZIP �i�pryE <br /> ARGNITECTO{�pESIGNER MIULADppE55 ��n. <br /> ��� PHONE <br /> GENE�CONLCTOp � �LMDRESS CIIY I�P PpONE SGTEtiCENSE• <br /> /1 !�1L� <br /> ��� <br /> MECXMII�q LONTRACTOR t�DDpESS Clry ZIP PIIONE STRE UCENSE/ <br /> PLUTABINGCONTR�CTOR M�IlA00RE55 CItY =�p PHONE <br /> $TATE LICENSE� <br /> GONiMCT PPoGE OF Wqi� r <br /> J Z S � �� 6 o O HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> DFSCRIBE WORN AND SOUAPE OOTAGE INVOL 0 �{n/ `�. CONT�CT VERSON NIO PfKK1E ND <br /> Q i�r' o� o�� C/`r \ U e <br /> 1 <br /> s ��1 Z_ d z�' <br /> I HEHEBY CERTIFY THAT I HAVE READ ANQ EXAMINED THIS <br /> aaovoseo use oF e drxan APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> r <br /> �P�j� Q....Xy PROVISIONS OF UWS AND ORDINPNCES GOVERNING THIS TYPE OF <br /> IEG�LUESCqIPTIONOfPRpP6q7Y�$�pyMgE�qypq�nA�HrypC0VIE5) WORK WILL BE CAMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOL THE GRANTING OF A PERMIT DOES NOT PqESUME TO GIVE <br /> ��T p��K oF AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REQUUTIN6 CONSTRUCTION OR THE <br /> �/ / PERFQRMANCE OF CONSTRUCTION.T AT I AM AUTHORIIED BV THE <br /> O b I Q (� aWNER OF THIS PROPERTY TO PER RM THE WORK FOR WHICfi <br /> C� � O G O Z— APPLI T�N IS MADE AND I OMPLY WITH THE STATE <br /> PMCEL TNf LD.NUMBER CON ORS LAW 1827 RCW AN 6200 WqC. <br /> CONSTRUCTIONLOANLENDER.�OIXIESS.TELEPIIONENUMBER - ����( �, <br /> —� K� <br /> URE O�TE <br /> - BUSINE55 LICENSE NO <br /> PLUMBIN6 MECHANICAL <br /> �• TYPE OF FlI(TURE OR ITEM FEE NO. TYPE OF EpU1PMENT FEE <br /> WATER CLOSET(TOILET) � NC—MiNOLG UN1TS � <br /> BATHTUB ; FORCED AIR SYSTEMS � <br /> UVATORY(WASH BASIN) � � F'EAT PUMP <br /> SHOWER ' <br /> ' UNIT HEATERS <br /> KITCHEN SINK 6 DISP i CLOTHE�DRYERS � <br /> DISHWASHER � RANGE HOpD , <br /> UUNDRY TRAV ; WATER HEATER � <br /> CLOTHES WASHEH � WOOD STOVE � <br /> URINAL � METAL FIHEPLACE(WOOD BUflNING) � <br /> DRINKING FOUNTAIN ; FIREPUICE INSERT(WOOD BURNING) ' <br /> FLOOR DRAIN � GAS FIREPLACE , <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> SINK(SEqVICE—BAR,ETC.) � GAS PIPING , <br /> EXHAUSTFAN <br /> � � <br /> � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S ' <br /> PERMIT S � PERMIT f � <br /> TOTAL FEE S ' TOTAL FEE f <br /> FOR OFFICE USE ONLY: <br /> FRONT SETgALK REAR$ETBACK $IDE SETBACN PUN GIIECN NUMBER FEF RECEIPT NO <br /> USEZONE IOT�REA V�CANTSIfE FEES VALUATION FEE <br /> _ ❑YES ❑ NO BUILOM(i � p� � <br /> GL� � � <br /> HEIGHiUMIT�TION NOOFDWEILINfi SqEOFBIIX'JTI ' <br /> UN11C � <br /> PlI1M01NG <br /> OCCUVANCY Iq M SIOWFS OCCUP�NT LO�D BASEMENT � <br /> ��P MECHSHICM. i . <br /> ❑YES ❑NO <br /> FIRESPRINKLEqRE�'0 RE.ASIXJ ADDIiION�LPUNGrIf.Ll( <br /> _ __T_– <br /> 0111E0 <br /> FIREAlMMp'.O'D PEA5,7N <br /> STAIE PUIl01N6 SIIfiCNM1GE ',��i7 <br /> "]/� <br /> iYPE OF f,ONST PLnNS AP�pOVED BY T'-- <br /> CITY OF EVERETT rusur,wopKS <br /> LOCAL SALES <br /> oe.E TAX CODE IS�705 T07AL 2 �i— <br />