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APPLICATI� N FOR CONSTRUC"-ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> O DEMOUTION p COMBINATION ❑ BUILDING � MECHANICAL ❑ pLUMBING ❑ SIGN <br /> PROJECT ADDRESS: 99// ��d /��/� �v�y�f f, w�J 9�ao� <br /> /�/�q��SEJiI .a?7�Ss o/6,/ .4✓e //U/ f=vGvc�� �r.�/�f �'1�aU / <br /> C�tt ZIP PMONE <br /> TENIINT MIJLl�DpRE55 �iTy jlP PIIONE <br /> �RCMTEGTOROESIGNER MqIAUDRE55 Cltt ZIP PMONE <br /> GENEfuLGONiR�CiOR M�II�DURE55 CiJY IiP PnONE SIATEUGENSE� <br /> MECHANIC0.CONTRACTOR MNI�DDHE55 CI�Y ZIF p11pNE SUTEUCENSE� <br /> PLUNBINGCONIR�CTfM MRIl�00RE55 Cltt ZIP P11p4E :TATELICENSE• <br /> CONTR/�T PRIGE UF Wpql( <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> OESCRBEMVRIt SOU�REFOOT�GEINVOIVE� C GTPEPSONNI PHpNENp <br /> e� .� (J[ll� ✓e ' Ll'� • <br /> + i> s�e. ' ' avG� ) 3Yk - �ao5 <br /> r G I HEREBV CERTIfY THAT I HAVE READ AND E%AMINED THIS <br /> seo use oc e�n�dra APPLICATION AND KNOW THE SAME TO BE TRUE AND COqRECi ALL <br /> PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPIIED WITH WHETHEH SPECIFIED HEREIN OR <br /> LECuLL0E5GPoPTIpHpippppERtt(SIqWNBELOWpqATT�CHTWOCOPIES) NOT. THE ORANTING OF A PERMI7 DOES NOT PRESUME TO GIVE <br /> �oT aiocK�oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION CF ANY <br /> / �/� �/ � OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> hTLrG/J� �/(/. � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> �./..- OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> "*'T^y�'Ov7 UI.3OO.JO"yO� APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PNiLEL TA7f I.D.MIMBER CONTRACTORS lAW 78.27 RCW AND 296.200 WAC. <br /> CONSTRUCTIONIOMlLENOER.11DDqESS.TEIEPNONENUMBER x Xn��nl�-�J //"/j�/_ <br /> G.jl� !./� �� yl(/ <br /> SIGN�TURE DI1TE� <br /> qTY BUSINESS 110ENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILE� � A/C—NHNDLO UNITS � <br /> BATHTUB ' FORCED AIR SYSTEMS ' <br /> UVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNIT HEATERS � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS � <br /> DISHVJASHER � RANGE HOOD � <br /> LAUNDRY TRAY � c p � <br /> � <br /> CLOTHES WASHER � WOOD STOVE , <br /> URINAL � METAL FIREP CE(WOOD BURNING) ' <br /> DRINKINGFOUNTAIN i FIREPLACEINSERT(WOODBURNING) i <br /> FLOOR DRAIN GAS FIREPLACE i— <br /> BACKFLOW pREVENTERS ; GAS RANGE ; <br /> SINK(SERVICE—BAH,ETC.) GAS PIPING � <br /> D(HAUST FAN � <br /> i ; <br /> � � <br /> i � <br /> � <br /> � � <br /> SUB TOTAL f � SUB TOTAI f ' <br /> PERMiT S � PERMIT S � <br /> TOTALFEE S � TOTALPEE S ' � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETgAGI( RE�RSETB�CN SIDESETB�CN P�ANCIIECMNUMBER fEF PECEIPfNO <br /> us'zoNE �ot�aEn V�CANT SILE FEES VAlUAT10N FEE <br /> ❑YES ❑ NO ONIDING i <br /> MEIGHTUMIT�TIOM1 NOOFDWELUNG SIZEOFBIDGR.I <br /> UNITS <br /> FIUMBING <br /> OCGUP�NCY NO M SIOwCS OCCUP�NTl0�0 BASEMENT I <br /> GAWP MECNIINIC�I <br /> ❑YFS ❑NO � <br /> FIRESPPMKLERREO'D RE�SON �DO�IION�L�UNCNf.LR <br /> 0111E11 � <br /> FIPEAIARMREO'D Pp�SpN <br /> i <br /> ST�IE BUII�INC S�IfiC1u0GE <br /> 1YPEOFf.ONST PLANSAPPp0VE08V CITVOFEVERETT PIIBIIf,WORNS <br /> LOCAL SALES — --%— <br /> D�TE TAX CODE IS 3105 TOTA� <br />