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APPLICATI��1 FOR CONSTRUCI" .aN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION Cl COMBINATION fl BUILDIN(i ❑ MECHANICAL f� PlUM81N(i fl SKiN <br /> PROJECT AODRESS <br /> py�Eq MAiI�DORESS CITY ZIP PNONE <br /> ,��:�t �,�.�a 2�2o i��,itF �G�e c-� 9F��; asy slos <br /> TENIINT �,I. M/ULADOfiE55 CITY ZIP PI'ONE <br /> W dWn-�lof t, S!"''"�' <br /> 11RCMTECTORDESIGNER M/J1�E55 CITY IIP PHONE <br /> pENEqµ�p�Tppp7pp MAILADONE55 CIlV ZIP PNONE SiATEUCEN5E1 • <br /> �•. cb I��fi @c� 3ISc sN �bM�(I l�.a� (��1� �l'lC2c�k �laSE��. �c�.fit.J��e�KG <br /> ANICALCONTRAC MAIL/�W�7E55 ��TY ZiP PF10NE � <br /> p����ryp�pry7p��pq MAIL�DDRESS Cltt ZIP PHONE STATELICENSE� <br /> a " 31ft S S o 3 S <br /> T�OFY1OR1 HEATING SYSTEM: ❑OAS f�ELECTRIC ❑ <br /> pEy�qME y�qM(�!q$p�ARE PoOTMiE MVOWED CONTACT PENSON ANO PHONE NO. <br /> � <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ' APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> vnoroseo use oF eu�pr+o i PROVISIONS OF LAWS AND ORDINANCES OOVERNINO THIS TYPE OF <br /> � S UV 0 WORK WILL BE COMPLIED WITH WHETHER 3PECIFIED HEREIN OR <br /> �yLL�����p�ppEqn.�y�q�.��i op �cx tor�es� NpT. THE 6RANTINO OF A PERMIT OOES NOT PRESUME TO OIVE <br /> ioT e�oc�c o� AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> -{�– � OTHER STATE OR LOCAL LAW RE6UU1TIN0 CONSTRUCTION OR THE <br /> � �L� N `l 11 PERFORMANCE OF CONSTRUCTION.THAT I AM AU7}iORIZED BV 7HE <br /> � OWNER OF THIS PROPERTY TO P@RFORM THE WORK WR M1F11CH <br /> ' APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTQF�lAW 1827 RCW AN��^D///���///pµµµ'''200 WAC. <br /> PNiCELTAfII.D.MA�EER / '� � � � � <br /> � �cl���Z -��'� -Uo I - ouo3 �j � ,�rl �/ 22�i' <br /> � CON57WICTION LOIJ!lENOER.ADp1ES3.lELEPNONE MIMBER DAIE �T <br /> .. . . SIONATURE <br /> CITY BUSINESS LICENSE NO. <br /> � • ��� MECMI1f11CAL <br /> � Np. TYpE OF FlIITURE WI ITEM FEE NO. TYPE OF FlXTURE OR ITEM �E <br /> � - � q/C—AIHNDLQ UNITS—H.P. ' <br /> WATER CIOSET(TOILE� � <br /> ��UB � FORCEDAIRSYSTEMS—B.T.U. M E.A. <br /> UVATORY(WASH BASIN) � HEAT PUMP ' <br /> g��R � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES ORYERS ' <br /> DISHWASHER � VENTILATION FAN � <br /> IAUNDRY TRAY ; RANOE HOOD ' <br /> CLOTHES WASHER � WATER HEATER ' <br /> URINAL ' WOOD STOVE � <br /> ORINKINO FOUNTAIN � METAL FIREPLACE(WOOD BURNINO) � <br /> FLOOR DRAIN � FIREPUCE INSERT(WOOD BURNINO) ' <br /> BACKFLOW PREVENTERS ; OAS FIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) � OAS RANaE � <br /> � QAS PIPINO � <br /> , E%HAUST FAN ' <br /> � <br /> i <br /> � <br /> � � <br /> i <br /> � <br /> � <br /> � SUB TOTAL S � SUB TOTAL E ' � <br /> � � PERMIT S � <br /> — PERMIT S TOTAL FEE S ' <br /> TOTAL FEE S <br /> FOR OFFICE USE ONLY: RECE�PTr+o. <br /> FppNT SE7g/�CK REAR SETHACK SIDE SETBACK PUN CHECK 1/UMBE� FEE <br /> ^jW%4 <br /> USEZONC LOTARE� VAC�NTSITE <br /> FEES VALUA710N �E <br /> ❑YES ❑ NO Bl11LDING <br /> �qNTLIMIT�TON NO.OFDWEUlN6 SIZEOFBLD6RI. /J <br /> i <br /> VNIT3 PLUMBIN6 J <br /> pCCUPANCY NO.O�STqdES OCCUPANTLOAD BASEMENT MECM�NICAL <br /> ��P ❑YES ❑ NO � <br /> ADDITIONIIL PIAN CHECK � <br /> FlRE�UNM REOD NEASON <br /> OTHER <br /> i <br /> FIRE SPRINKLER REO'] REASON STATE BUILOMG SVRCMARGE � _ <br /> � <br /> tYPEOFCONST. PUNSAPPROVEDBY CITYOFEVERETT PUBLICWORKS � <br /> LOCAL SALES <br /> D�TE TAX CODE IS 3105 TOTAL <br />