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APPLICATIO�: FOR CONSTRUCTI.�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVEREI"f,WA 98201 •259-BB10 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �, MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: //D8 �U C KFQ .4d� <br /> �rJ.v/J�/ ._%�n.irF�i //DE ZuckF2 NdE. i6zo/ 2�-G6�28 <br /> �--' MMLADpIlE55 CIIY S�P PHONE <br /> 1EN11NT MNIMDPf55 GIIY ]�> PIIONE <br /> MpG11TCGT OR OES�GNER M�II�DDf1E55 CITY ]i� PMONE <br /> GENEMICdITp�C70R MAIVDDf1E55 CitY tIP PI�ONE StQEIILENSF� <br /> � � `� <br /> MEQIM�ICALCONTR�CTOR MAILAWRk55 f.ITV Zli` V110NE Si�tEULENSE� <br /> PIUNBINGCONTR�CTOR M�ILAODRES$ CIfY Z�P P110NE ST�TEUCENSE� <br /> CONTMCfPRICEOFWOn� OO� HEATING SYSTEM: f�GAS ❑ ELECTRIC ❑ <br /> OESCRIlE Y/ORN�ND SOUIIRE FOOTI�GE INVOlVEO CONGCT P[RSON�NO PHONE NO <br /> p AT G T6 .a <br /> �/�4 TC� i-.'i 2 C£i.�i G � .4 <br /> I HEREBY CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT AlL <br /> rnoroscovse ov au�dr+a PROVISIONS OF lAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � WORK WILL BE COMPLIED WITH WHETHEP SPECIFIED HFREIN OR <br /> LE6ILDESGPoPTIONOFPROPERTYf�b���OWORARACMTWOCOViES� NOT. THE GRANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�aK or_ aU7HORITY TO VIOI.ATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTflUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORI2ED BV THE <br /> OWNER OF THIS PROPERTY TO PERFOHM THE WORK FOfl WHICH <br /> APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> P1INCELTl1%ID.MUGMER -� ^ <br /> CpHSTRUC110N IONI IENDER.�DDRESS.TELEPNONE MUMSER <br /> Y/^L <br /> 5 D�TE <br /> CITY BVSINE55l�CENSE NO � <br /> PWMSINO MECHANICIIL <br /> NO. TYPE OF flIRURE OR ITEM FEE NO. TYPE OF EGUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—MiNDLa UNRS ' <br /> BATHTUB � FORCED AIR SYSTEMS � <br /> � LAVATORY(WASH BASIN) � HEAT PUMP ' <br /> SHOWER � UNITNEATERS ' <br /> ' KITCHEN SINK 8 DISP � CLOTHES ORYERS � <br /> DISHWASHER � RANGEHOOD ' <br /> UUNORY THAY ; WATER HEATER � <br /> CIOTHES WASHER � WOOD STOVE ' <br /> URINAL ' METAL FIREPLACE(WOOD BURNINGI ' <br /> DPINKING FOUNTAIN FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR DHAIN � GAS FIREPIACE � <br /> BACKFLOW PREVENTEflS � GASFtANGE � <br /> SINK(SERVICE—BAR,ETC.) � ,3 GAS PIPING ' <br /> EXHAUSTFAN � <br /> i <br /> i <br /> � <br /> SUBTOTAI S ; SUBTOTAL S ; <br /> PERMIT f � PERMIT f � <br /> TOTALFEE f ' TOTAIFEE S <br /> FOR OFFICE USE ONLY: <br /> FRpJTSETBACK REARSEID�CR S�DESETB�GK PUNd1ECNNUWfER FEF nEf.EIPiNO <br /> USE2oNE IOt�PE� VACANi511E FEES VALUATION FEE <br /> ares ❑ �o nunnwa <br /> HEIGNTLIMITATION NOOFOWEIUNb S12EOiBlDO/f.l � <br /> VNIfG pIUMpING _T_ <br /> OCCVPANLY NO 0�SIOPiES OGCUP�Nf 10�D BISEMENT MEf,ruNiCM. � _ <br /> ona�v <br /> ❑vE5 ❑ �+� <br /> •DD1110NAL�l AN C�1(GK � <br /> flRESPRINKLERPEO'D �E��� � <br /> on�en <br /> FlRE/�WiMREO'D AE��O'+ <br /> 9A1[OUII�Wf.51111C11�fiCE <br /> TYPEOFf,pNST PlAN5MCP0VE�BY CITYOFEVERETT �liqlif.WO�rcS 1 <br /> �_�� <br /> LOCALSALES — <br /> o.re TAX CODE IS 9105 TOTAL <br />