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APPLICATI�V FOR CONSTRUCT��ON PERM11r <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION �$ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ IGN <br /> PROJECTAODRESS�\ ��0�/)�� ,f��G <br /> �T lj� <br /> ONMERV+� MA ADOiiE55 C11Y ZIP PHONE <br /> TE�/\ ��� � �!'I Y �` / O � �a I � GIT�� / P�-'Tp �� VNONE%5�03 .3b 3 Q l o 0 <br /> SPec f, o uSQ � <br /> �RCNICECTORDESIGNER MAIIADDPES`.' CITY IIP PHONE <br /> _ T2�ni��ay <br /> GE/ ! l ��✓U�/l �uL�OUREgSO� 4 ' � � ver�T� �/r'I PO NE U I VO `r�If_-DW L 176 KO <br /> P <br /> MELNANICQCONTRAC70i1 MIqADDRE55 CITY ZIP PIIONE STRELI�ENSE� <br /> (�UQI��-Y l-{�Q�i n a <br /> o JM9INGCONTR�C c�ni�nwN[ `/ / ��� I�P PNONE STREUCENSE� <br /> .�Ob / r] SOr� ���im�ina <br /> GONLRACT PRIGE OF W011N /� <br /> �p QfJJ HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> DESCRIBENVqN�ND50UA: FOpTAGEW OIVED / CONT TVERSON�VIDPHONENO <br /> �E' ��� �; ,-�� 1P m h,�r��dwa., '�03- glon <br /> j"''eS �—��a�a �..z <br /> re, �� � C � �lJ�� I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSEO U uiidrxi APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT qLL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�LOE1S�C{pIPT10NOFPpppEq7y�5�pyMgE�OWOqATT/�LHTWOCOPIES) NOT. THE ORANTING OF A pERM1T DOES NOT PRESUME TO GIVE <br /> �Or— �AC_B�OCK or AUTHORITY TO VIOLATE OR CAN�FL THE PROVISION OF ANY <br /> T� <br /> . � OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORV.ED BY THE <br /> . � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> hPPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> ru5,��n�r,uue-�'�� _n /,�^ �-�0 � CONTRACTOHS LAW 18.27 RCW AND 296200 WAC. <br /> 7 r'X y <br /> CON TION IOAN LENDER.�DqiES TELEPIIONE NUMbER x ' - 9 G <br /> r� n � SM.NA <br /> � O�TE <br /> CITV BUSINESS LICENSE NO. �— <br /> PI.UMBING MECHANICAL <br /> NO. TYPE OF flf(TURE OR ITEM FEE NO. TVPE OF ECUIPMENT FEE <br /> WATER CLOSET(TOILEn / � A/C—A/FiNDLG UNITS �— <br /> �[ BATHTUB ; FORCED AIR SYSTEMS � <br /> / 1 <br /> UVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS � <br /> _i— <br /> KITCHEN SINK 3 DISP i CLOTHES DRYERS , <br /> DISHWASHER � RANGEHOOD � <br /> LAUNDRY TRAY � WATER HEATER � <br /> � <br /> CL07HES WASHER � WOODSTOVE i <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFIOW PREVENTERS ; GASRANGE ' <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING � <br /> ' EXHAUSTFAN � � � <br /> i � <br /> i <br /> : <br /> � i <br /> � i —�— <br /> % SUB TOTAL f ' SUB TOTAL S � <br /> PERMIT f � PLRMIT S —r— <br /> TOTALFEE S � TOTALFEE S <br /> FOR OFFICE USE ONLY: � ��7a <br /> fRONTSETB�LK PE�RSETBACN SIDESFTB�CN Pl�NC11ELNNUMBEO � i1Ef.EIPTAO <br /> `z " � " D S �'S�Lo7 <br /> Zo' <br /> USEZONE io�eae�nf V�CANTSITE FEES VALUATION FEE <br /> _ '� ' /�7 YES O NO OIIILUIN6 � Q C i j/ <br /> MEIGMT LIMIT�TION NO OF OWEl4N� 512E OF 9� ljl � <br /> L� <br /> , � ur+irs I"It32 �r Liv,N4 '- I� <br /> . ! q o S�F .,AGE v�uunwc <br /> OCCUPANCY NO Oi510WE5 OL C UIMNf L O�� B�S E M EN T �� i <br /> GPOUP MECNeNILAI 7 i <br /> 3 -1 Z Id /,4 ❑res "o �,00mor+eiruva¢cK j �� <br /> FIRESPHINKLERREO'0 REASON <br /> �__ <br /> OtHER � <br /> FIREAURMREO'D RE�SON <br /> STAIE BUIIDiNC SUtiOUpGE --_ ��L� <br /> iY{+E OF f,ONSi rinNservnov�o or CITY OF EVERETT P1101if.WORY.G — /J��� <br /> J� LOCAL SALES ' ` '-` <br /> — �I oaE ,3 1 �� TAX CODE IS 9105 TOTAL I� <br />