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APPLICATIO i FOR CONSTRUCT►JN PERMIT <br /> CITY OF EVEHETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8010 <br /> O DEMOLITION O COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS: �5�/,3 J�LCr.FviEk! /,qne <br /> �✓ere.t� 98�D3 .Z�6 353 - c�1r'b <br /> OYVNER yM�ADDRE55 �Itt piP PNONE <br /> ��rt eS �eec�S <br /> TEN�NT uqL��Di1E55 GTY lIV PI�ONE <br /> �qGNITECT OR�ESIGNER M�II ADORE55 CITY JiP PHONE <br /> CENEfUILONTR�CTOR MAqA0DRE55 �IIY )IP PIIONE SfATEIICENSE� <br /> �GU42Y' <br /> MECHANICAI CONTRACTOR MAII ADDRE55 Cltt ZIP PI{ONE SiATE IILENSE� <br /> PIUYBINGCONTR�CfOR MAUDDRE55 �IfY IIP PHpNE STATEUCENSE� <br /> CONTMCT PPoLE OF MORK <br /> ��lO, ��- HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> DESCRIBE N AN SOU�RE FOOT�GE INVOIVED � CONTACT PEPSONANO PNONE NO <br /> i 0 ilECf7o�c. <br /> /I�a nz� Cvas <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> FROPOSEDUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> ��SI�P/'(Ce PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHEH SPECIFIED HEREIN OR <br /> IEG�lDESCRIPTIONOFFROPERtt�5110WNBElOWORATfALHM'OCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or eiocK oF AUTHORITY TO VIOLATE OH CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGUUTING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER JF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MAOE AND I COMPLV WITH THE STATE <br /> PARCEL UJf I.D.NUMBER CONTRACTORS LA 18.27 CW AND 296200 WAC. <br />. CONSTRVCTONIOANLENDER,ADDPESS.fELEPNONENUMBER X (� � �//�/Qb <br /> SIG TU � � D�TE <br /> C11Y BUSINESS IICENSE NO <br /> PLUMBING MECHAN�CAL <br /> NO. TVPE OF flXTURE OR ITEM FEE NO. TYPE OF EGUIPMENT FEE <br /> WATER CLOSET(TOiLEn ' A/C—ARiNDLG UNRS � <br /> BATHTUB ; FORCEDAIRSYSTEMS ' <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITNEATERS � <br /> KITCHEN SINK 8 DISP ; CLOTHES ORYERS ; <br /> DISHWASHER � R,4NGE HOOD � <br /> UUNDRY TPAY � WATER HEATEfl ; <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT(WOOD BURNING) i <br /> FLOOR DRAIN � GAS FIR[PLACE � <br /> BACNFLOW PREVENTERS ; GASRANGE ; <br /> SINK(SERVICE—BAR, ETC.) � GAS PIPING � <br /> ' EXHAUST FAN ' <br /> � � <br /> � <br /> i � <br /> SUB TOTAL S ; SUB TOTAL S ' <br /> PERMIT S � PERMIT S � <br /> TOTALFEE S � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> CpONTSETBAGB RE�RSETBAGR SIDESETB�CX PlANC11EGNNUMflFf1 fEF RECEIPiNO <br /> usezonE wT�nee V�C�Nt51TE FEES VALUATION FEE <br /> ❑YES O NO pUIIDWC � <br /> HEIGHT UMITATION NO OF DWELIING SIZE Of BIDCRI � <br /> UNIIC <br /> PLUA�IIIN6 <br /> � <br /> OCCVP�NC� NO OvSIMtlES OLCUPANTLOAD B�SEMENT MECIUNIC�I � <br /> GRIX1P <br /> ❑YES ❑ NO '- , <br /> FIRESPflINKLENREO'D �EASON <br /> •OD�IION�L PUN C11CCR � <br /> i <br /> O111En � <br /> FIREMAflMREO'D RE�SfN�I � <br /> S1A1E OUIIUINR S�ItiC1uf10E <br /> i <br /> -- r— <br /> TYPEOff,ONST PLANSAPPPOVEDOY CITYOFEVERETT rueim.wonKs <br /> LOCAL SALES --'— <br /> o�tE TAX CODE IS 3105 TOTAL <br />