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� APPLICATIL�� FOR CONSTRUC�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br />� 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOUTION ❑ COMBINATION ,� BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: �^F � � rnCl�l� <br /> ON?!ER . MNLI1Dd1E55 CI7Y 21P PNONE <br /> �-Ot,llSf. �-1 £� a-"4- � I 11�C�-Ci�� f/'f�t� �SJ01 �Sa - ��7"� � <br /> TENIINT MAll�0IX1E55 CITY Z�P i'110NE <br /> ARLMTECT OR OESIGNER MAtI�DDRE55 CI1Y ZIP PHONE , <br /> GENEP4lGONTP�CiOR MNL�UDRE55 LIIY l�f`�7a�1 P�IONE SGTEIIC[NSE� <br /> Gcc ii tl i��ucPt � 1n(� �ny "ls (��cn�idf (/ir�� l� l�o�^,.n�f '7%v-o97� r���asIo66KZ <br /> MECHANIC�LCONTRIICTOR MAILAODRE55 CITY � ZIV P110HE STATEUCENSE� <br /> PLUMB�NG CONTRAC70R M�ILAOIXiE55 CItY 21P PHONE ST�TE LICENSE� <br /> �pJTMLT PRICE Oi M/qIN <br /> HEATING SYSTEM: �,GAS ❑ ELECTRIC ❑ <br /> 7ESGRIBE WORN AND'SOUARE fO07ACE INVOIVED CONT�GT PERSON/�NO PMd1E NO <br /> 1h t ( f i cP an S oui i -Sa-' �� <br /> � • rFr � <br /> , <br /> . I HEREBV CERTIfY THAT 1 HAVE READ AND E%AMINED THIS - � ��� • <br /> APPUCATION AND KNOW THE SAME TO 8E TRUE ANZ CORRECT ALL � ' ' "�-� �" . <br /> rnorosro use oF euaar+a PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TYPE OF � <br /> � Df WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �¢w�oescrovTior�araarenni BELOWp1�TTACNiWOCORES) NOL THE 6RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � ior �� Q��� '�ov AUTHORITY TO VIOLATE OR CANCEL THE PROVISION Of ANY <br /> OTHER STATE OR LOCAL LAW RECaULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> oCOo� - - a-U APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> VFRCEL TA%I.D.NUMBER CONTRA TORS LAW 18.2�PCW AN�296.200 WAC. <br /> CONSTR TIOH l M!LENDER, ESS. LEPN E NUMBER x J C� � O���� ��S -�� <br /> � � '� _ f SIGN URE DAIE <br /> 7.� ([) PO,, �7 r)YIP � ^ - -a3' ��T�'BUSINE$$IICEN5EN0 <br /> PLUMBINO MECHANICAL <br /> � NO. TVPE OF fl7(TURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILEn � NC—NHNDLG UNITS ' <br /> BATHTUB ; FORCED AIR SYSTEMS ; <br /> UVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNITHEATERS ' <br /> KITCHEN SINK 3 DISP i CLOTHES DRYERS i <br /> DISHWASHER � RANGE HOOD ' <br /> UUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING� ; <br /> DRINKING FOUNTAIN ; FIRENLACE INSERT(WOOD BURNiNG) � <br /> FLOOR DRAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING . <br /> EXHAUST FAN <br /> � <br /> � � � <br /> /' .fDr- Or . � <br /> _ , <br /> � <br /> � ' <br /> � T <br /> SUB TOTAL S ; SUB TOTAL f ; <br /> PERMIT S � PERMIT S <br /> TOTALFEE E ' TOTALFEE E ' � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETPACK PEAfi SETBACN SIDE SETBRCK �UN CIIECN Nl1MBFR FEF ���Q �fCE�PT NO <br /> 7,0 2 0 �' �2 `� <br /> USE20NE �OTARE� V�C�Ni51fE FEE VALUATION FEE <br /> 2 �G1�O ❑VES YA NO /� � <br /> OUILOIN(: �' .�_� <br /> HE�GHT LIMITATION NO OF DWEILING SIZE OF BIDG�f.I <br /> 2 UNITS , � x `� `D � !'IIlA�01NG � <br /> V /'I <br /> OCCUPANCY NOMSIONFS OCLUPANTIO�U BASEMENT ' <br /> G�OUP � MfCN�NIC�t _ __ <br /> ❑YES �'�O <br /> FIRESPRINKLERflEO'D �E�SON �DDIIIONRti'UNC�IfCR _ _ <br /> i <br /> 0111ER � <br /> FIREAURMPEO'D RE�SDN � <br /> $IAIE BUILOM6 SIIRCIUOGE �LL�7 <br /> 7VPEO�f,ONST PLANSMPppVEp Y PIIPIIf,W0f1N5 - — � _�J <br /> CITY OF EVERETT r�_ , <br /> J LOCALSALES <br /> -/�{ uniE s- TAX CODE IS 3105 TorAL c'�Cc I S%1 <br />