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� ,� � <br /> . .APPLICATIOA FOR CONSTRUC7 .JN PERMIT � <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259-8810 <br /> [�I DENIOUTION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> �PROJECTADDRESS: ��� I I��tFIf ,� �UE.�F�� <br /> , ER MulA0piE55 CIiY ZIP PNpNE <br /> �l_ou�s� �.« ��- � i �1�«nl� f.�.�F-f-f ��an� a sa -h �� � <br /> 1 NANI MNtAOD.^.C55 C17Y IIP PIIONE <br /> �RLHIiECTOR0E51GNER MAll11DORE55 GITY 71P PHONF <br /> �N /dGONiRACiOR M1ILAODRE55 C�IV 71P PI10NE CIATEIICENSE• <br /> � v- }�) ����ec�1�;�.. t�1L S 3 111o,.Rot 9�a�� 56�-�94-�Z�.� ��� -��r-6�F9 <br /> �M H ICALLONTRACTOR M/JI�DORE55 Cltt IIP PIIONE ST�iE UCENSE� <br /> PLUMBWGCONTN�CTOP M�ILApOHE55 CIfY ZIP P110NE STATELICENSE• <br /> CdITMGT VMCE O�WOfIK <br />� <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> OESCiMBE W011N�NO SOWAE FOOTAGE INVOIVED CONTAGT P[RSON ANO PlIONE NO <br /> I HEflEBY CERTIFY THAT 1 HAVE READ AND EXAM�NED THIS <br /> I APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> rr+oroseo use oF au�tara PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LE6l1l�E$CRIPTIONUF%iOPERTY1���lOWOp�RALMTWOCOPIES) NOT. THE GRANTINO OF A PERMIT WES NOT PRESUME TO GIVE <br /> �ot �� '�ov AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL lAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BV THE <br /> IOWNER OF THIS PHOPERTY TO PERFORM THE WORK FOR WHICH <br />, r - ` -D O APP��CATION IS MADE AND, I COMPLY WITH THE STATE <br /> E�i�i.o.r+uMa¢ CONTRA ORS LAW 1 7 RCW D 296.200 WAC. <br />� CONSTRVCTION lOM!LENDEP.I100RE55.TELEPHONE NUMBER � �� U- t�j <br /> T RE DATE <br /> CITY BUSINE55lICENS[NO <br /> PLUMBIN6 MECHANICAL <br /> � NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF ECUIPMENT FEE <br /> I WATER CLOSET(TOILET) � /UC-A/HNDLO UNfTS ' <br /> BATHTUB ; FORCED AIR SYSTEMS ; <br /> � LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS ' <br /> KITCHEN SINK 6 DISP ; CLOTHES DRYERS � <br /> DISHWASHER � RANGEHOOD ' <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) ' <br />� DFINKING FOUNTAIN ; FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOF DRAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> I SINK(SERVICE-BAR.ETC.) � GAS PIPING � <br /> � IXHAUST FAN ' <br /> � ' <br /> i <br /> � ' <br /> � ; <br /> � <br /> � ' <br /> SUB TOTAL f ; SUB TOTAL f ; <br /> PERMIT S i PERMIT S � � <br /> TOTALFEE t ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETB�CN RGR SETBACN S�DE SETB�CR �UN CIIECK NUMBFR fEF RECEIPT NO <br /> Z <br /> ll5f ZONE tot�n¢� V�CANI SIfE FE S VALUATION FEE <br /> � <br /> ❑YES ❑NO BUIlO�NG � <br /> HEIGNTLIMITATION NOOFDWELLING SIZEOFBLOGRI � <br /> UNIiS Pl11MBMG <br /> _�_ <br /> OCCUP�NCY NO M SIMtlES OLCUP�NTIO�D BASEMENT � <br /> GROVP MfC1UNIG�t i <br /> ❑YES ❑NO ' <br /> i <br /> FIRESPRINKLEHREO'D REASON �DDIIION�LPUNC��f.Glc � _ <br /> � <br /> 0111ER <br /> FIREALARMREO'D NF�S(N+ — —�� � <br /> STAIE BUIIDMG 511RCH�IIGE �.r)� <br /> }.L <br /> TVPE Of f,ONST PlANSAPPROVCD 0Y CITY OF EVERE7T PIIp1 if,WOpeS . <br /> LOCAL SALES - — — <br /> o�,E TAX CODE IS 3105 TOTAL <br />