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APPLICATIC] FOR CONSTRUCT jN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• E\�ERE7T,WA 98201 •259-8810 <br /> ❑ DEMIOLITION ❑ COMBINATION ❑ BUILDING MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: Z5�3 �j�//�-(/�Q�f /��UO <br /> ONMER MNl�00RE55 CITY 1iP PHONE <br /> J�N�s Sm�,► as,3 O,r�✓a�r��.J g�✓v ��aeerr 9�203 <br /> IE/UNT M111t�00RE55 CITY ZIP FIIONE <br /> �RLHITEGT OR DESIGNER AUIL/�OORE55 GTY 11P PHONE <br /> GENERALCONiR�GTOR M�IL/�WRE55 dTV IIP P110NE $fATE110EN5E� <br /> YECHANIC/�ICONTPA�TOR M�ILAppRE55 CITY ZIC P110NE ST�T[UCENSE� <br /> S�v,c-k! /r�v,�,vh /ZD 2— L/I�$N(A"'� �vr 9�z��l 3s333qY S,�t�-Ui c, i n��D 3 <br /> %UMBMIGCONTRIICTOR MMLADDHE55 Cltt ZIP PIIONE STATELILENSE� <br /> CONTMCT PPoCE OF WOi1K `� <br /> � HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br /> OESCPoBE NORK AND SdIARE FOOTAGE INVOWEU CONT�CT PERSON�ND PHONE NO <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%P.UINEO THIS <br /> vnoPoseo usE ov eunarx3 APPLICATION AND KNOW THE SAME TO BE TRUE AND CGr7RECT ALL <br /> PROVISIONS OF UWS AND ORD�NANCES GOVERNING THIS TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> lE(3ALDESCMPfIONOFPROPER7Y�5110WNBELOWp1�TT�CNTNKICOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PqESUME TO GIVE <br /> ioT e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LO:.'AL LAW RE6ULATIN4 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PANCEL TNf I.D.MlYBER CONTRACTORS LAW 1827 RCW AND 29G200 WAC. <br /> CONSiRUCTqN LONI LENOER.ADpqES5.7ElENh�NE NUTABER �M�j� �`— (�— G�^�� <br /> SIGNAT E D�TE <br /> Cltt BUSINESS IICENSE NO <br /> PLUYBIN6 MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF ECUIPMENT FEE <br /> WATER CLOSET(TOILEn ' A/C—AMNDLG UNfTS � <br /> BATHTUB � FORCED AIR SYSTEMS � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATEFS ' <br /> KITCHEN SINK d DISP ; CLOTHES ORYEHS � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY ; WATER HEATER ; <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL ' MEfAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GASRANGE ; <br /> SINK(SERVICE—BAF,ETC.) � GAS PIPING <br /> ' DCHAUST FAN ' <br /> � � <br /> i <br /> � � <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S ; ; <br /> PERMIT S � PERMIT S � � <br /> TOTAL FEE S � TOTAL FEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBACK SIDESETB�CK f'L�NGIIECKNUMfl[R fEF RECEIPTNO <br /> uselor/E toreREn vnC�r+iSiiE FEES VALUATION FEE <br /> ❑YES ❑ NO OUIl01NC � <br /> HEIGHT LIMIT�TION NO OF OWELIING SIZE OF BlIX3/f I <br /> UNITS P�U401NG <br /> � <br /> OCCUPIINCY NO(%SI(vbES OLCUMNTIO�D BASEMENT MECNnNICnL <br /> GROUP <br /> ❑VES ❑NO — i <br /> FlRESPNINKLERHEO'0 REASON ADDIIIONq.PLANC��F.LB i <br /> —_T_ <br /> OIHER i <br /> FlREAIMMflEO'D AE�CpN i <br /> ST�iG BUIl01N6511qC1URGE i <br /> iVVE O�f,ONST PL�NSAPPROVEDBY CITV OF EVERETT �IIflI1C WOfiNS <br /> LOCAL SALES — ----'— <br /> oqTE TAX CODE IS 3105 TOTAL � <br />