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APPLICATIO.. FOR CONSTRUCTI.�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-BB10 <br /> O DEMOLITION ❑ CONA8INATION �BUILDING O MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PflOJECT ADDRESS: <��� g /VIoN!-'c1E I�-UFNu <br /> b2i/+nl �h6r1lr�r� SNoP� - 9S'F-y AvEn�� NE EuE2-,-rw�4¢S�S 33�/-62.c,� <br /> OW��ER MUI�WRE55 CITY Zm PHpNE <br /> TENNIT MqLMORFS$ CIIY 7�� P110NE <br /> �'ly�f�-N I�I�IyE'�tD Ot.JNEfL_ <br /> �RLICTECT di OESIGNER MMl ADORESS CIIY 7m PHONF <br /> �-1/'+'IJ �I�Eh)p. OG�NFbC <br /> GENER�ICONTMCTOR M�IL�DDRE 5 C11Y :m pIIONE SIATELICENSE� <br /> MECHANICQCONTMCTOR MAllA0DRE55 CITV 71� PIIONE STATEUCENSE� <br /> PLUAMINCCONTR�CTOR MAILADORESb CIfY ZIP PHONE STATEULENSE� <br /> CONiMCT PIVCE OF WORK `� <br /> HEATING SYSTEM: ❑GAS ELECTRIC ❑ <br /> OESCRISE WORN�NO SOUARE FOOTKsE INVOIVED � � CONi11Ci PE�SONANO PNONE NO <br /> v — F_ t ' N ' lu 20 , c- � � -6�0 <br /> o2T � G GF <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> vnoroseo use oF eu� uo APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC7 ALL <br /> �u PROVIS�ONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> lE6AL�0�E5C�RIPT�'IO�NOFApPEpTY�$NOWNBELOWOR�TT�CHIWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> toT y_�__;�e�ocK U Zf�oF PlNF N�,t�2_ST AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> D I U OTHER S7ATE OR LOCAL LAW REQUUTINO CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOHI2ED BY THE <br /> OWNER OF THIS PROPERIY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MAOE AND 1 COMPLY WITH THE STATE <br /> PANCEL TNf I.D.MMIBEP CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> O`- oT•H'—(7I ^O00 <br /> CONSTRUCTION lWN lENOER.�OORE55.iElE1M10NE NUMBER x�,N� �d <br /> ���E SION�TURE O�TE <br /> CITY BUSINE55 LICENSE NO <br /> P����� MECHANICAL U � –' <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EGUIPMENT FEE ' <br /> WATER CLOSET(TOILEn � NC—AhiNDl4 UNRS � <br /> BATNTUB ; FORCED AIR SYSTEMS ' <br /> LAVATORY(WASH BASIN) � HEAT PUMP • , t <br /> SHOWER � UNITHEATERS � <br /> KRCHEN SINK 8 DISP ; CLOTHES DRVERS ; II <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY ; WATER HEATER ' <br /> CLOTHES WASHER i WOODSTOVE � <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) ' �� <br /> DRINKIN6 FOUNTAIN ; FIREPLACE INSERT(WOOD BURNING) � <br /> ROOR DRAW � GAS FIREPLACE � i <br /> BACKFLOW PREVENTERS ; GASRANGE ; , <br /> SINK(SERVICE—BAR,ETCJ � GAS PIPING � �. <br /> ' EXHAUST FAN ' II <br /> � � i <br /> � � I <br /> , � <br /> , <br /> � � <br /> SU8 TOTAL S � SUB TOTAL S � �', <br /> PERMIT S � PERMIT f � <br /> TOTAL FEE S � TOTAL FEE S ' <br /> FOR OFflCE USE ONLY: � =��� <br /> FRONTSETBI1pN / REApSETBACR / SIDESFTSACk / PUNCII€CKNUMBE� FEF /�J REf.EIPTNO <br /> � C S J <br /> USESONE� � IOTAREA V�C�NTSITE` FEES VALUATON FEE <br /> — ❑YES ❑ NO OUIlO�NC J�-J S� � 3 <br /> ME16HT LIMITATION � NO OF OWEIUNb 512E OF BLOORI � <br /> rl� UN115 ��O plpMplNG � <br /> LO <br /> OCCUPANCT 1q OiSfMtlFS OCCl1PANfL0�0 BASEMENi � <br /> MECM�NIt�I � <br /> a - 1 �J� — � <br /> ❑YES Np <br /> FI SPR�IN`KLERREOD REASON �OD�110N�LPU.�LHf.CK � <br /> N, OiIIER . <br /> FlREAURMREO'0 RE�CON <br /> yJ� STe1E0lILLAING511t1C1UfifE � � <br /> -- r— <br /> TYPEOFf,ONSf P��NS�PPR �oer CRYOFEVERETT runnr.wones � ; <br /> ��'�� LOCALSALES —�— <br /> V u�re I 2 -I t_ 9� TAX CODE IS 3105 TOTAL '�" ') ; ��� <br />