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APPLICATIL .il FOR CONSTRUC''�DN PERMIT <br /> CITY OF EVERETT•BUIIDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDIN(i ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> � .IOJECT ADDRESS: Ipp2, GRAt1D �V� <br /> M�k�Fewr� . 106Z GvaauD kde. Fa/ev��-I+ Gxzoi � -zao-��-s 39� <br /> ,, OMMER MAtl�00RE55 CIIY 21P PHONE <br /> TEN�NT MNLADd1E55 CITY 21V PHONE <br /> (n�a2 �n�x-rinJG 2c�ib F. P�r.�6u«� ��rrt� �BnZ 2oL ���—gi99 <br /> ARGHITECTOROESIONER MNl1lDOnE55 CIIY ZIP PHONE <br /> _ri�� <br /> 6ENEiWCONTRIICTOR MNL�WilE55 GITY IIP PIIONE SUTELICENSE� <br /> MECHANIC/�LCONTRACTOR M/JIADONE55 CITY IIP PNONE STATEIICENSE• <br /> MUAlIN6CONTRACTOR MAILAODi1E55 CIfY IIP PiqNE STATELILENSE� <br /> CON7MCT PIMCE OF MqRK <br /> $2 DOO /�'�,zj'= HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> OESdtllE WORII 11NO SOU�RE FOOTAOE MVOV/ED � Y a LONTACT VERSON ANO P1qNE NO. <br /> V� Yl 7 (� <br /> WI�L, hP,l.1) <br /> � G � �� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND NNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> °�������a� PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPE OF <br /> �TA.I�A-�f- WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �y�o�scwr a riavEmr Is��own aeirn+�n��yN�c�� NpT. THE ORAMINO OF A PERMIT OOES NOT PRESUAAE TO QIVE <br /> iot M�M l�1 i5l/L eiopc 2J3 pc AUTHORITV TO V�OLATE OR CANCEL THE PROVISION OF ANY <br /> T ¢[cpQpCp inl OTHER STATE OR LOCAL LAW REODUTINO CONSTRUCTION OR THE <br /> ✓OL OF pU3T5, I� '7g PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> N 5 Ho7NnN GtN7y� OWNER OF THIS PROPER?Y TO PERFORM THE WORK FOfi WHICH <br /> Wk5H7AlG(b� APP��CATION IS MADE AND 1 COMPIV WITH TNE STATE <br /> PNICELT/�JfID. R CONTFjA6T 1827 RCW ND 298.200 WAC. <br /> -Z YJ/ �GO x �� ��/ '� [� <br /> CONS7RIICTION LWN lENOER.�OOIIE55,IELEP110NE R <br /> SKiN�IUHE D�TE <br /> CITY lU9NESS IICENSG NO. <br /> PLUMlINfi MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENi FEE <br /> WATER CLOSET(TOILE� � A/C-MiNDlO UNfTS ! <br /> BATHTUB ; FORCED AIR SYSTEMS ; <br /> UVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS ' <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS � <br /> DISHWASHER � RANGEHOOD � <br /> � UUNDRY TRAY ; WATER HEATER ; <br /> CLOTHES WASHER � WOODSTOVE � <br /> �q�� � METAL FIREPLACE(WOOD BURNING) ' <br /> DRINNING FOUNTAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR OHAIN � (iAS FlREPLACE ' <br /> BACKFLOW PREVENTEFS ; ���E T_ <br /> SINK(SERVICE-BAR,ET^•.) � GAS PIPING � <br /> ' IXHAUST FAN ' <br /> � <br /> i ' <br /> i ; <br /> � <br /> � ' <br /> SUB TOTAL f ' SUB TOTAL f ; <br /> � <br /> PERMIT S � PERMIT f � <br /> TOTAI FEE S � TOTAL FEE f ' <br /> FOR OFFICE USE ONLY: _ <br /> FNONT SEiB4pl REAq SEiB�LK SIDE SETBACK PIAN LNECK NUMNER FEE RECEIPT NO <br /> 2.�6 //��.� <br /> use ior� l0T AREA v�cuir sir¢ FEES VALUATION FEE <br /> � <br /> — ❑YES ❑ � BUILDINC ��S i — <br /> HEI6NTUWTATIdi NOOFOWELLINb SIZEOFBLO(i/fl � <br /> UNIfE � / ( VIUMBING i <br /> 7� <br /> �UpANCY Iq Oi S�MFS OCCUPANT LOAU BI�SEMENT � MECMu1ICAl i <br /> ❑YES B'�10 <br /> i <br /> Fl ESPRWKLERflEO'D NE�SON �DOIf10N�LPL�NCN�CR _ <br /> � <br /> O7NER i <br /> FlREMMMNEO'0 RFASpN � <br /> ST�IEBUIl01N6511RCHAnGE � � �`� C) <br /> _' � <br /> TYPE O(f,qJST PL�NS APF(IOV 0 BV CRY OF EVERE7T �IIAI If.WORNS ' <br /> �f- , � LOCAL SALES —'`— <br /> .�L-�� o�Te g !y 6 TAX CODE IS 3105 TOUL � <br />