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APPLICATIuN FOR CONSTRUCI �ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 • (425)257-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �ECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: Z�Z 7 ��r�� ���jj Q�ZJ/ <br /> OWNER M�ILAODRE55 CISY ZIP PHONL <br /> �� ��i/ZA/�l � /7� �'u��� �✓ �� 4113�1 2S�' O/�Q <br /> TEN�Ni IA�IL�DOHE55 LITY ZIP P110NE ,a'.,'�',::�.�",�^y��(�y� <br /> �fh�C , . : �s� <br /> — <br /> ARCIIrtF.CTOR�E5IGNER MAl1�D�RE55 Cltt ZiP PNpNF <br /> G�Er ER�l CO.yTf1�CTOR MML�DURESS FITY (� ]IP PIIO4E $ qfE LIC[NSE� ' <br /> n►w Il�1A'f�,2 �{i�f�.l� �� "(�J I�r� `4l�1� �8/Q� 2�sz-��1 ��I,�J/03iP� <br /> MECN�NIC�LGONTPRCTOF MAIL�WqE55 CITY 21P PHONF. Si�TFLICENSE� <br /> PIUMBING CONTR�CTOR M�IUWRE55 CITY ZIP PHONE STPiE ULENSE r <br /> CONfpACTPP�CEOFWOAN ��` � <br /> � HEATING SYSTEM: GAS ❑ ELECTRIC ❑ ��-} <br /> � ,:': ;� s . <br /> OESCRIBEWORK�NOSOUAREfOOT�CEINV VED CONTACTPERSONANDPNONF. O � � 1 � ��t'� <br /> 7.��jcv <br /> � �� • , <br /> �:r. '",''�°� <br /> � �p i I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS �•.. �-�c+, <br /> � APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL � �,-�s('.-,� �-t�;��k� <br /> PROPOSEO VSE OF BIIILDING 5 F pROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF , `������ <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIPIED HEREIN OR - .�•.�'�;�..;'�r_�� <br /> lEWL0E5CRIPTIONOFPROPERTY�SHOWNBELOWq1�TGCNTWOCOPIES) NO7. THE GRANT�NG OF A PERMIT DOES NOT PRESUME TO GIVE - �'" " � <br /> �oT eiocK ov AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY � �1�� <br /> ,, <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE ��t�y� <br /> PENFORMANCE OF CONSTRUCTION.THAT I AM AUTHOFiIZEO BY THE ' - -+�::e <br /> OWNER OF THIS PROPERTY TO RERFORM THE WORK FOR WHICH ���!,a� <br /> APPLICATION IS MA �1 OMPLY WITH THE STATE �_ � .�•.�$^, <br /> PMCEL T�%I D.NUMBER CONTRACTORS LAW �,R D 6.200 WAC. �y-, <br /> i D � l J ! � ` ; � r���i <br /> CONSTRlICT10NLO�N LENDER,A�ORESS.TELEMION NUMBER <br /> f <br /> x � e-,_.�,;'�7, <br /> SIGNATURE D�TF. _ _ �}j�i ' � <br /> qTY BUSINE55 LILENSE NO ' <br /> PWMBING MECHANICAL �� � ;�+;Fa <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE '��;'��-`��i;�`�'�:`"_;;�� <br /> WATER CLOSET(TOILET) � A/C—AMNDLG UNRS � '. � �){'w.�' <br /> BATHTUB ; FORCED AIR S1'STEMS ; � � ����rt!�, <br /> LAVATORY(WASH BASIN) � HEAT PUMP � � �iY'' <br /> SHOWER � UNITHEATERS ' �c•�a.,�,i ��i�� <br /> KITCHEN SINK 6 DISP � ' -'� � �'�y <br /> ; CLOTHES DRYERS , c` ��}� <br /> DISHWASHER � RANGE HOOD , � �' '�i <br /> � ` <br /> LAUNDRY TRAV ; WATER HEATER ; � .�; <br /> CLOTHES WASHER � WOOD STOVE � ' `'�'�' �� <br /> �;.�.�y <br /> URINAL � METAL FIREPIACE(VJOOD BURNING) ' ��r � <br /> DRINKINGFOUNTAIN i FIREPLACEINSERT(WOODBURNING) i . i ���"' •�'t''� <br /> ��-����i i9.�:i <br /> FLOORDRAIN � GASFIREPLACE � �':�,�-����,'-��.��'�a,a,s,� <br /> BACKFLOWPREVENTERS ; GASRANGE ; . � -�tj�� <br /> SINK(SERVICE—BAF.ETC.) GAS PIPING � - � �'� ' �����- <br /> � !:.:.�^:Y,`�;•ti..:`...�:-. <br /> � E%HAUSTFAN -.,r' � 'r`�;B"• <br /> � ,��..__ >':'x-, <br /> — •',;y^�r,'; :�y?I. <br /> � — , � <br /> � � <br /> � <br /> SUB TOTAL b � ; SUB TOTAL S ;CX> ' <br /> PERMIT E � PERMIT S �tJc � <br /> TOTALFEE S � TOTALFEE S (nS '0� � <br /> FOR OFFICE USE ONLY: <br /> PRONTSFTpRCR REARSF.TA�LN SIDESEfB�CI( PUNCIIECNNIIMflFH PEF �FCFIPTNO <br /> SvW <br /> USE 20NF t07 AREA VACAN�SITE FEES VALUATION FEE <br /> ��� <br /> ❑YES ❑ NO pWIDWf• � <br /> HEIGHT IIMITATION NO.OF UWELUNG 54E Oi 9lOGR1 — � <br /> UNII$ f+lUF�91NG � <br /> �--- �— <br /> OGCUPANCY Np pt SIORIkS OCLUPANT LOAD O�SFMENI MFf.NnNiGI <br /> Gf10U� <br /> ❑YES ❑Np � <br /> FIRESPRINNLERPEO'D �F4SON ADDiI1pN�I.PIRNCH[GK <br /> ----i-- i <br /> � <br /> ou�en , <br /> PIRE nIARM REO'D RF�SOV —i-- <br /> 5i�t[BIIIIbMG$UfiC11AfIGE <br /> �rre or r.ovsr r�nNs nrrr+oveo or CITY OF EVERETT runi ic wonKs <br /> LOCAL SALES -- — — --�—' <br /> opTE TAX CODE IS 3105 TOTAL <br />