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APPLIC�4TIG_J FOR CONSTRIlCT.JN PERM�T <br />CITY OF EVENETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•BB10 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING LI MECIiANICAL O PLUMBING ❑ SIGN <br />PROJECT ADDRESS: <br />� �� ����,� v� � <br />/ f�1.�E"r-_ _ �206 <br />cirv tm rnoee— <br />ARCNITECT On OESIGNEn M�II �ODf1E55 CIfY i��• PIIONE <br />�Sp�� -- - <br />GENEMICONTP�CI0f1 MA1A011PE55 f.IIY JIP PIIONB $UiEIICENSE• <br />MECHANICALCONTR�C70� MAIIADDRE55 CIIY 1�P PIIONE STALELILENSE• <br />PLPUBINGCONTRAC70R MulAIlORE55 CII\' !W p110NE STAEUCENSE� <br />DESCRIBE VIORN �N� SOUARE i001�GE INVOlVEO <br />A�vO <br />KPS'J <br />PPOPOSEO USE Of <br />wr 3 eiocK %/ G, or,� <br />�l/.! R � �— <br />CONSTAVGTION IOIW LENOER /ADRESS. IElEP110f1E NUMOEI7 <br />PLUMBIN6 <br />NO. 1'YPE OF flXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />OISHWASHER <br />UUNORY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN _ <br />FLOOR DRAIN <br />BACKFLOW PREVENTEHS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />iRONTSETBACK PE�� SFTpACK <br />uSEZONE <br />HE�GMT LINITATION <br />OCCUP�NCY `10 ( <br />GRWP <br />FIRE SPRINKLER REI <br />FIRE AURM RE�'D <br />lOf APFA <br />NO OFOWELUNG <br />UN11$ <br />OGCUP�NIIO�U <br />RFASO4 <br />RE45pY <br />�'UN$ �PP11pVE❑ <br />os+r <br />SI�F. SET9�CR <br />11EATING SYSTEM: �3AS ❑ ELECTRIC ❑ <br />rnHinr� rnison n,m ruor+e �io <br />i NEREOY CERTIFY THAT 1 HAVE HEAD AND E%AMINED THIS <br />, PPLICNION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />f'ROVISIDNS OF LAWS AND ORDINANCES GOVERNING TH�S TYPE OF <br />�VORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />�� �� I�OT. TFiE GftANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />.�7' A� T��IORITY TO V�OLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STAf E OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RC A 96.200 WAC. <br />/ %/�i ��� <br />516N�1Uf1F. -T� DAI <br />VAGANf 511G <br />OYE$ ❑ NO <br />512E Oi OIOGrt I <br />❑YEi ❑ N7 <br />CIIV OIISMf:5511C[NSC NO <br />MECIIANICAL <br />NO. TYPE OF EQUIPMENT <br />NC — MiNDLG UNRS <br />FOf10ED AIR SYSTEMS <br />HGAT PUMP <br />UNIT {iEATERS <br />CLOTIIES DRVERS <br />� WUOLI S10VE <br />•— — <br />� Mf_iAL FIREPLACE � <br />; FIf7EPlACE INSERT <br />� GI1SfIRFPLACE <br />� GASRANGE <br />� GAS PIPING <br />CITY OF EVERETT <br />IOCALSALES <br />TAX CODE IS 3105 <br />—I SUB TOTAL E <br />PERMIT E <br />TOTAL FFE S <br />PI�NLIICf.RN1lMllffl fFF �ECEIPTNO <br />,5�/iS-7 <br />� fEES VALUATION <br />ounun�c <br />Pl11MOM(: <br />MFCII�NICM <br />MUI IIONAI PI AN f,lll f.N <br />pO1Pt <br />SLA1P flllllllll!(: SlllltlinlltiE <br />runl �r. wonec <br />TOTAL — ��� ����---- — -- <br />FEE <br />