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APPLICATI�! FOR CONSTRUC�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: �pp2 GRAt�ID �.1,I�. <br /> ly,keFe.wo . iooz Gwaaun kde. Fa/ev�� GRwi � -zcYo-�3-s 39�0 <br /> „ OWNER M/JLADORESS CiTY IIP PMONE <br /> TENANi M/JLMdiE55 CITY 21P PMONE <br /> (/15pA2�n�KtING 2U14 E. �F�'..�gUC/� �E�-RLE �1811Z 2o(i ��3�-8'IR9 <br /> 11RCM1ECTOROESIONEN MAIIADURE55 CITY Z�P PNONE <br /> ���� <br /> GEHERnL CONTP�CTOq MULAD�RE55 pTY ZIP PIIONE 5ld5 LICENSE� <br /> MECNIwICl1LCONTRACIOR M�RADORE55 CITY IIV PNONE ST�TEUCENSE� <br /> PLUMBINGCONTRnCTOR MAIIADDRE55 CITV IIP PNONE STAtELICENSE� <br /> CONiRACT PPoCE OF M/ORK <br /> $Z DOD HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> DESCPolE WOq1c�ND SW�RE FppT�GE INVOIVED CONTACT PERSON AND PHONE NO. <br /> r n n J Y Q� <br /> Wi� i12�t1 ' <br /> � <br /> �� � � HEREOY CERTIFY THAT I HAVE READ AND EXAMINEO THIS <br /> PRpPOSED USE OF BVILDINO AP ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> ROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHEN SPECIFIED HEREIN OR <br /> �Ey�o�scmv a+ocPrroeeATr(s�wvmee�ow9RA�yNh cov�e � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br /> ior� !al i51/G eiocK �3 oF <br /> 8� AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> T Prcpp�qrQ in/ OTHER STATE OR LOCAL LAW REGULATiNO CONSTRUCTION OR THE <br /> ✓OL 9 OF PLH7$� � '7g PERFORMANCE OF CONSTRUCTION.THKf I AM AUTHORIZED BY THE <br /> /V S FloM/�K GcAII'y� OWNEH OP THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> W�µ��D� APPLICATI MADE AND I COMPLY WITH THE STATE <br /> VMCELTiVII.D.NUMBER CONT TOP° iB27 296200WAC. <br /> l _ � 3� -�oo G 8 � 9 � <br /> GONSTRUCTIpH LOM!LENDER.AODilE55.TELEPlIOHE NUMBER <br /> SIGNATUfiE �— D�TE � <br /> CITY BUSINE55 LICENSE NO. <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF fl%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn � NC—AMNDLO UNfTS ' <br /> BATHTUB ; FORCED AIR SYSTEMS ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS i <br /> DISHWASHER � RANGEHOOD ' <br /> ' IAUNDRY TRAY ; WATER HEATER � <br /> CIOTHESWASHER � WOODSTOVE � <br /> URINAL � METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN ; FIREPLACE INSEFiT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; GAS RANGE � <br /> SINK(SERVICE—BAR.ETC.) � GAS PIPING � <br /> D(HAUST FAN ' <br /> � <br /> i ' <br /> � ' <br /> � ' <br /> � i <br /> SUB TOTAL S ' SUB TOTAL S � <br /> � <br /> PERMIT S � PERMIT S � <br /> TOTALFEE t � 70TALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SSiBACN REAR SETBNCN SIDE SETBACN PLAN CIIELK NUMBEN FEF RECEIPT NO <br /> �250 <br /> USE ZONE l0T�REA v�c�r+r sire F ES VALUATION FEE <br /> � <br /> DYES ❑ NO Bl1ilDlNf. � <br /> HEI64TLIMITATION NO.OFOWEWNO SIZEOFBlD6R.1 <br /> VNIiS PWMBINC i <br /> � <br /> OCCUPANCY NO Of St(YtlfS OCCUPANT IOAD BASEYENT uECHAN�CAL i <br /> GRWP <br /> ❑YES ❑NO ' <br /> ADDITION�L CUN CHECK � <br /> FIPESPRINKIEfIREO'D PEASON ' — <br /> O7HEH i <br /> FIREAURMREO'D AE��ON � <br /> $TAlE6U�lDINCS�IRCH�fiGE -- � '� <br /> � <br /> TYPEOFf.ONSf Pl�NSAPPROVEDBY GTYOFEVERETT �U911f.WORNS � <br /> _� <br /> LOCAL SALES <br /> D�7E TAX CODE IS 3105 TOTA� �. <br />