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APPLICATIO.� FOR CONSTRUCT vN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT;WA 98201 •259-8810 <br /> ❑ DEMO�ITION ❑ COMBINATION ❑ BUILDING O MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: � �] .�J z S in : T� /�►/� , `ver�� 7T� �,/(' . -r'j82o / <br /> �u��ibtan T�eaTa�/t�� f� D 8�x �3�f� /�10.�0�.>, .rv, �'3 By3 <br /> ER Mel�UOnl55 Cltt Iir rMOwE <br /> �L �es7'o�cr�-io� t z9 5��.'r�. A ✓e. rEue,n�rr GJA. P�zot ze�'?� <br /> lEN/JlT YIULN%MF.55 GTY ZiP PNONE Q� \ , <br /> o J <br /> �RCMTECTORDESIGNFR MMIMONE55 Gltt 7�n PiONE <br /> GENER�IGOHTReGTOR MN'ADDf1E55 CIIV tm P�qNE SGTEIICENSE� <br /> (�N4 n/ 7- <br /> MECNiVJIC�ICONTR�CTOR M�ILADORi55 Cltt I�P PIIONE ST�iEI�CENSE� <br /> PLIIMBINGCONTR�GTOR MqLA00RE5S CI1Y IIP PNONE STA7ELICENSE� <br /> L W ITIUCT PRICE OF <br /> �00 HEATING SYSTEM: �]GAS ❑ ELECTRIC ❑ <br /> DESGMlE W011g11yo SOU�NE FOOT�GE INVOIVED {4, n/� ��i/ WNTACT ERSONAND PHONE NO �O� � 8 S <br /> AiSBarllle �xfsT'..> as A � <br /> i� i -�^ / <br /> R �o sP/�ir /� T l�oa r . <br /> a'�X �Y 3�N Sep,�T I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> W101'OSED VSE OF BVILDI APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT qLl <br /> O tS TO�"QT/OYj PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE O�� <br /> lECJ1LDE5CRIPTIpJOFPRpPEpry�$�qyMBEIOWOqATTACNTWpCOPIES) Y'ORK WILI BE �OMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE aRANTING OF A PEHMIT UCES NOT PRESUME TC GIYE <br /> LOT B��K or AUTHORITY TO VIOLATE OR CANCEL THE FROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGUUTING CONSTRUC710N OR THE <br /> — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL T/J!I.O.NUMBER CONTRACTORS lAW iB.27 RCW AND 296.200 WAC. <br /> � ' 2 - � , <br /> CONSi11UC710NlOMlIENDER.AOOHESS.TEIEPNONENUMBEN �n��, GI �� 6��1__'II/Z�/� � <br /> — SIGN�fURE D�TE �T <br /> Cltt BUSINESS IICENS[NO <br /> � � PLUM6:'�. MECHANICAL <br /> � NO. TVPE OF FlI(TUqE OR ITEM FEE NO. TYPE OF EpUIPMENT FEE <br /> � WATER CLOSET(TOILE7) � NC—AIHNDL�UNITS � <br /> BATHTUB ; FORCED AIR SYSTEMS � <br /> UVATORY(WASH BASIN) ' <br /> � HEAT PUMP , <br /> SFIOWER � UNITHEATERS � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS ' <br /> DISHWASHER ' <br /> - � RANCE Ht�OD � <br /> � UUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE , <br /> URINAL � METAL FIREPLACE�WOOD BURNING) <br /> ORINKIN6 FOUNTAIN ; FIREPLACE INSERT(WOOD BURNING) ; <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GAS MNGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> ' ExHAUSTFAN � <br /> ' ` � <br /> 17�n �til i vU � � <br /> � J_ <br /> 1 <br /> 1 <br /> I <br /> SUB TOTAL 5 ' SUB TOTAL f ; <br /> PERMIT S i PERMIT S <br /> TOiALFEE f � TOTAIFEE S � <br /> FOR OFFICE USE ONLY: Ij�jc o�� C`wrt+rr <br /> FPONT SETB�CK PE�R FETB�CK SIOE SE7B�C8 P N CUECN NUA1BEf1 FEF REf.EIPT NO <br /> ! !_�� <br /> J <br /> USE20r+E IOtAREA yAc�Nf51fE FEES VALl1ATl0 ' FEfi <br /> ❑YES ❑NO —�— <br /> — pl11lDINf. � �l <br /> HEIGHTIIMiATION NOOiDWEl4N6 --- � �I <br /> UNIIS 512E OP BLOOR I <br /> 6 rwumvc ; <br /> OCCUP C1' iq(%SIMIES OCCUP�Ni LO�D BASEMENi � <br /> G WP MEC�InNiCnl <br /> � ' ❑YES NO — <br /> FIRE RM ENRE '0 RE�SON 4UOIIION�l1'lANfufCe � ; O <br /> �ES �oofiN CJOE on�en � <br /> FIFEAIAqMREO NE��ON <br /> �e Si�iE OWIDING SIIDCIUt10E '� <br /> iYFEOFf,ONSf rtnNse nov¢oer CITYOFEVERETT �Ii911f.W0�NS <br /> �/o.v.���ff��� LOCAL SALES — — <br /> o��e 1-a�-9� TAX CODE IS 3105 70TAL ;5 <br />