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,�, r, <br /> APPLICATI4.i FOR CONSTRUC7 .JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-BB10 <br /> ❑ DEMOUTION ❑ COM�BINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: �(i>�O s (i�-//9�r I.� � <br /> ODVIpER MNl�Op1E55 Cltt 21P PIqNE <br /> p�c/L /'fe'LLv 76ao .�.�.��� a.- ���� � 3yr szy.r3 <br /> TElMN7 � 4/JL�DDRE55 QtY 21V P110NE <br /> MCMTECT OR OESIGNER M/JL�DDRESS CITY lIP PMONE <br /> 1��t! �'�—N�c. J/Z/7-Gt�T�SryE LKSrr�i 9Fzr�- 3.35' yz� � <br /> 6ENERACONTR�LiOq� MULGDpIF55 Clf\' I�P PHONE 5G7ElICENSE� <br /> iYGYT� izyco <br /> MECNIWICACONTF�CTOR M1UlADDHE55 f.�tt ZIP PHONE STATEUCENSE� <br /> PLUA6INGCONTR�CTOR M�ILAOORE55 LIfY 21P PIqNE STAIELICENSE• <br /> ��7 <br /> LONTRACT PRICE OF MqQN <br /> ��/X,�Z G.q��-�e-- � S �� HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> OESCRIlE WORK�NO SqU1RE FOOT�6E INVOlVEO CONT�CT VENSON�NO P110NE NO <br /> ��jc 3 � 3 Cr�-.— .�•-.r- 60 3 — � <br /> G � S . i=� <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Ai PLICATION AND KNOW THE SPME TO BE TRUE AND CORRECT ALl <br /> anoroseo or eu�drxi pqOVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � � WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> lE6/�lpE5CplpTlpNpFPRpPEpTY�5110WN8ElOWOH�TT�CHTWOLpMES� NOT. THE 6RANTIN6 OF A PERMIT DOES �JOT PRESUME TO GIVE <br /> ior a�aK _oF AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REODUTIN6 CONSTRUCT�ON OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM TME 1NOAK FOR WHICH <br /> APPLICATION IS MA�E AND I COMPLY WITH TME STATE <br /> TA%I.D.MIMBER CONTRACTORS LAW 1827 RCW ND 296200 WAC. <br /> 3� -�i �ao3 - oav �� �( <br /> CONSTRVCTONLOANLENDER.AOdiESS.TELE%10NENUMBER x�LGC/1.�T �""���� <br /> SIGIGTURE U�TE <br /> CITY BUSINE55 tICENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FlKTURE OR ITEM FEE NO. TYPE OF ECUIPMENT FEE <br /> WATER CLOSET(TOILEn � NC—M,�NDLd UNfTS ' <br /> BATMTUB ; FORCED AIR SYSTEMS ; <br /> UVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS ' <br /> KITCHEN SINK 8 DISP ; CLOTHES DRVERS � <br /> DISNWASHER � RANGE HOOD � <br /> LAUNDRY TRAV ; WATER HEATER i <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL � METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN ; FIHEPIACE INSERT(WOOD BURNING) � <br /> FIOOR DRAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; GAS RANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> EXHAUSTFAN <br /> i ' <br /> � � <br /> i � <br /> i � � <br /> ' � � <br /> SUB TOTAL S ' SUB TOTAL S ' <br /> i ' <br /> PERMIT S � PERMIT S � <br /> TOTALFEE S � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FNONT SETBIICK � PE�R SETBACK � SIDE SETB�ICN PUN CII���R � FEF//r �� QECEIPf NO <br /> y J <br /> �sE ia+ �1' iot�ae� V�CAN�SITE FEES VALUATION FEE <br /> / � <br /> ❑YE$ ❑ NO OUIlDIN6 i - <br /> HEIGHTLIMITATION NOOFDWELUNG SIIEOFBIOG/T.l <br /> UNIiC /� P1111A01NG � <br /> � NQ. — T <br /> � <br /> OCCUPANCY NO(%SfMtlES OCCUP�NTtO�D B�SEMENi �.���.�H���� � <br /> a�aur <br /> V-1 ❑YES O — � <br /> FIRESPflINKLERREOD AEASON ADDiIIONQPLANCMf.CN , <br /> �- <br /> 0111E� <br /> FIREAIARMREOD AEASON <br /> ST�IE BUIl01NC SIIIICIURGE �C� <br /> TYVE OF f,ONSt PIAN$�PPROVED BY CITY OF EVERETT ���A��f.WOfIKS _-i— <br /> .�� LOCAL SALES '--�- <br /> /� D�iE (o TAX CODE IS 3105 TOTAL � ':7� <br />