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APPLICATIO.J FOR CONISTRUCT.JN PERIOAIT <br /> CITY OF EVERETT•BUILDING DIVISION �C+�� <br /> 3200 CEDAR STREET•EVERETT, WA 99�01 •259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION �BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS: - � �'� i �9;i' " ` ' �.,'�% i;i.,,.: " �. <br /> OWNER MULI�WnESS CI1Y 2�P PNONL �. - <br /> l��!}n-'.',.� F/,' r.= /�;; ' I ��' I , ':�- �i„ r,? ' . ' �I ,. � " -�J�' - <br /> � / <br /> TENIWT' / MqlAUW1L55 CIIY jlP � PIIONE, ' ' <br /> ARGMTCGTOROESIGNER Mu1�DOBE55 ptY JiP MpNF <br /> GENER�ICONTR�CTOR MMLMpt1E55 CIIY )ip PiION[ GIelE11C[NSE� <br /> ��'� - � <br /> �i '"/q <br /> / .111 f_ 1 iit/�i �/./���_l J / � r. .-L� '-1 � J' <br /> �' �U <br /> MECNNIIC/J.CONTR�GIOR ' M�R�DDRESS ,� f.ltt pl{`- PIIONE ST�iELICENSE• <br /> �I <br /> PIUMBINGCONTR�GTOR MAIL�WRESS GIfY IIP P1pNE STUEUCFNSE� <br /> CONiMCT VPoCE OF WORR <br /> HEATING SYSTEM: ❑GAS O ELECTRIC ❑ <br /> DESCRIBE WORN AND WAqE f00TM.E INVOLVED LONT�CT PCRSDNANO PHONE NO <br /> ij� ��I�f�.�� <br /> I <br /> /� /_ <br /> /..`f I /,//I� .� f.� <br /> _ ,.., _ 1 HEREBV CERTIFY THAT 1 NAVE READ AND E%AMINED THIS <br /> '"� " � APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> rnoroseous[ore�n�dra PROVI5104S OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF ' <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR � <br /> LEGALOESCRIPTIONOFP{qPERTY�51qWNBEIOWOi1ATT/�CHTWOCOPIES� NOT. 1'HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior eiocK oF AUTHORITY TO VIOLATE OR CANCEI THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REOULATIN6 CONSTRUCTION OR TF1E <br /> PERFORMANCE OF CONSTHUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMLELTN(I,O.M1MBEfi CONTRACTORS LA'vV 1827 RCW AND 29620a WAC. <br /> CANSTRUCTIONIOANLENDER./�OORESS.TELERIONENUMBER x�� � � l "� J/�.y� _ <br /> � yf)t� r,-� �.� t_ <br /> Si6N�TUPE�� D�TH <br /> GITY BU5INESS IICENSC HO <br /> PLUMBING MECMANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF ECUIPMENT FEE <br /> WATER CIOSET(TOILEn � A/C—AIHNDLG UNITS � <br /> BATNTUB ; FORCEDAIRSYSTEMS ' <br /> LAVATORV(WASH BAS�N) � HEAT PUMP � <br /> SHOWER � UNITHEATEHS � <br /> KITCHEN SIIJK 3 DISP CLOTHES�RVEHS � <br /> DISHWASHER � RANGE HOOD <br /> UUNDRY TRAY � WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METALFIREPLACE�WOGDBURNING) ' <br /> DqINKING FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) i <br /> F� JOR DRAIN GAS FIREPLACE � <br /> B;�CKFLOWPREVENTERS � GASRANGE ; <br /> SINK(SERVICE—BAH.ETC.) GAS PIPING <br /> IXHAUSTFAN <br /> i <br /> i <br /> i � <br /> i i <br /> SUBTOTAL S ; SUBTOTAL S <br /> PERMIT S � PERMIT S � <br /> TOTALFEE f � TOTALFEE S ' � <br /> FOR OFFICE USE ONLY: <br /> iRdITSETBACK REARSF.TB�CK S�DESFT6�CN 1`I�NCIIECNNUlMO�C�p / fEf �ECFIPINO <br /> �c�`�� , <br /> USE20NE IOTeBEA WL�NTSIIE FEES VALUATION FEE <br /> ❑YES ❑ NO OUILDIhb ��v � <br /> NEIGIIT LIMIT�TION NO Of OWEUING SIIE OP BIDGII l i <br /> UNIIS PtUM01NG � <br /> — T <br /> OCCUP�NGY NO(%SIMC6 OCCUP�NILC�D BA�:MENT � <br /> GRWP MECIUwCAt � <br /> ❑YES ONO -- —i <br /> FIRESPRINNIEqREO'D �FASON �DDI11pN�LIRAHGICGN , <br /> �— <br /> ou�cn <br /> FIREAIARMREO'0 RF�[pN <br /> $1�1[11NIUMC S�IRCIUIIGE ` ��G��� <br /> nrEovr,oNsr PlnNS�PPPOVEDBY CITYOFEVERETT �Ilplif,WORKS <br /> LOCALSALES — — � <br /> o�rE TAX CODE IS J105 iOTAL (l�� <br />