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APPLICATIC l FOR CONSTRUCT )N �ERMIT <br /> CITY OF EVERETT•BUILDING OIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259•BB10 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL p PLUMBING ❑ SIGN <br /> �PROJECT ADDRESS: ZZ-U Z OQ,l�1CG5 Av� C V(2Ci T 1,t )'Fl <br /> �1ER MML�OqiESS Cltt ZIP PNONE 4jJ�:���� <br /> `� tP�t�i §�iSF� Hc:e.E�.� E��FF- �I'��� �otsi �� N.:. mAQY��u�u.F, w� 9�zw <br /> �NANT IANI/�DOBE55 CITY IIP PIIONE <br /> 5��7t`� EIa��F C51aY�H�� � ��0 c;uwe���c� i u�. L��t�QTY) ZZ�Lc�414c5� �9—(�iL.� <br /> AR(:MTECT OR DESIGNEN Y�II ADDRESS Cltt llf` PHONE <br /> GENERILLCONTR�CTOR MAILADDRE55 CITY ZIP PNONE SGTEUCENSE� <br /> ���� � <br /> MELN/�NICALCONTRACTOR MI111A0IX1E55 f.ltt ZIP PNONE STATEUCENSE� <br /> PLUMBINGCONiRACTOR M�It�DORESS Citt IIP P110NE STATEIICENSE� <br /> CONTMGT OpICE OF YNRN ^ ` <br /> �hl HEATING SVSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> OESCPoBEWORNIINDSIXUREFOOTIIGEINVOLVED CO fA P RS NUPNONE �- <br /> �,� � i � � <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND K�JW THE SAME TO BE TRUE AND CORRECT ALl <br /> PROPOSED USE OF BNLdNO 1 PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPE OF <br /> �V'� l� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> iec�u oescmvrwn oF rno�nrv Isxo BELOW pi ATTACN TWO COPIES� NOT. THE 6RANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> bTHEH STATE OR LOCAL LAW RE6ULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV h1E <br /> OWNER OF THIS PFiOPEFTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MAOE AND 1 COMPIY WITH THE STATE <br /> FNiCEL TAII I.D.MAIBER %ONTRACT 5 LA,'J 18.27 RCW ANO 296200 WAC. <br /> f <br /> CONSTIIUCM7NlOMlIENDER.AD0f1E5S.TElEPNONENUMBER .t'J �� �l i4�9� <br /> SIGN�TURE DAT <br /> GItY BUSINESS lIC[NSE NO. <br /> PLUMBIN(i MECMANICAL <br /> NO. TYPE OF Fl%TURE OR ITEM FEE NO. TVPE OF EGUIPMENT FEE <br /> WATEH CLOSET(TOILE� � NC—NHNDl6 UNfTS ' <br /> BATHTUB ; FORCEDAIRSYSTEMS ; <br /> , UVATORY(WASH BASIN) � AT PUMP � <br /> SHOWER ' UN EATERS ' <br /> CHEN SINK 6 DISP ; CLOTH DRYERS � <br /> DIS ASHER � fiANGE H ' <br /> LAUND Y TRAY ; WATER HEATE � � <br /> CLOTHES ASHER � WOODSTOVE � <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOU IN � FIREPLACE INSERT(W BURNING) � <br /> ROOR DRAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVEN RS ; GAS RANGE � <br /> SINK(SERVICE—BAR, C.) � GAS PIPING ' <br /> � EXHAUSTFAN ' <br /> � ' <br /> i ' <br /> � ; <br /> � <br /> — � � <br /> SUB TOTAL t ' SUB TOTAL S ' <br /> i ' <br /> PERMIT f � PERMIT f � <br /> TOTALFEE f ' TOTALFEE f ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETl1�CK AEARSETB�CN S�DESFTB�CN MANCIIECNNUMIIfR FEF REf.EIPTNO <br /> USE 30NE LOT 11RE11 V�CANT SITE FEES VALUATION FEE <br /> � <br /> ❑YES ❑ NO BUIl01NC. �� <br /> NEIONT LIMIUTION NO OF DWELLING SIIE O�BLOG41 � <br /> UNIfS PU140MC � <br /> T <br /> OGCqCU�P/�NCY Iq Oi SI(VtlES OGCUPANT IO�D BASEMENT MECNnNIf.�L � _ <br /> O�ES ❑NO � <br /> f1E�50N �DDIIION�Li'UNCIICLR , � <br /> FIRE SPflINKLER REO'D — <br /> � <br /> au�en ' <br /> FIREALMMREO'D RE�SON —_ ;� <br /> St�IE BUII����C SU�C11�fICE <br /> TY�EOFf,ONSi PLANSAPPROVEOBY CITYOFEVEREIT winim.wonH� i <br /> LOCAL SALES —� <br /> o�tE TAX CODE IS 9105 TOTAI � <br />