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► <br /> AFPLICATI4.� FOR COI�STRUC'VIslN PERMIT <br />� CITY 7F EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STIIEET• EVERETT,WA 98201 • (425) 257-8810 <br /> I <br /> ❑ DEMOLITION ❑ COMBIMATION O BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />� `P,�ROJECT ADORESS:�(`I l� y.7N[� J'T G/�sG�T 1,��� S�'r�2u�' <br /> /V �l L iZiZICK 17�O�:r-��J ��� c- .cs����,� N� �.���,r� G��. �,�z� 3�.� -�r�-�o 7 <br /> o er+ uni�aooaess ciTr zir vnor+e <br /> TE::ANT MAIUDORE55 LITY ZIP PMONE <br /> �RCHIT(GT OR OESIG�lhR �ARII AD�RE55 CI1V ZIP PNONF <br /> u�c..�ZIZ/UC /�(U ZC'Ar� SE}Y+i.t <br /> �ENEf1AL CGNiMCTpq MRII AppRE55 cnr iir r��oNe srnrE uter+se• <br /> MF.CHANICALCONTRAGTOR M�RADDFESS Cltt ZIP ANONE $TATFULENSE� <br /> PLUMBINGCONTPaf,TOR MnILAD�RE$5 Cltt ZIP PHONE STATELICENSE� <br />� CON[RACTPRICEOFWOPN <br /> HEqTINI'� SYSTEM: ❑ GAS ❑ EI.ECTRIC ❑ <br /> OESCRIBE WOFK AND$UUPRE FGOTAGE INVOLVED CONTACi PFRSONAND PHONE NO <br /> �� � L� � /7✓U � r' .. f f _ <br /> O �c0-Fi�.ij I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> — nri LIC.^.TiviJ AND KNOW THE SAME TO BE TRUE AN�CORRECT ALL <br /> PPOPOSED USE OF AUILDING PROVISIONS JF LAWS AND ORDINANCES GOVERNING?HIS TYPE OF <br /> `NORK WILL BE COMPLIED WITH WHETHEF SPECIFIED HEREIN GR <br /> IEGAL0E5LRIPTIONOFPROPERTYISHOWN9ELOWOHPTfACNTYOCOPIES) N07. THE GRANTING OF A PERMIT DOES NOT PRESUME 70 GNE <br /> ior eixK_ oF AUTHORITY TO VIOLATE OR CANCEL THE PFOVIS:ON OF ANY <br /> OTHER STATE OR LOl:AL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS M.4DE AND I COMPLY WITH THE STATE <br /> � PARCELTA%:D.NUM9ER CONTRACT/OR� S LAW 1827 RCW AND 296200 WAC. <br /> CONSTFUGTIONLORNlENOER.AD�RE55.TELEPHONENVMBEP x� LJ�"/ l��,G II' /'�� _ <br /> SIC �TUPE Oni[ <br /> CITV BOSWESS UCENSE Np <br /> � PUIMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OP E�UIPMENT FEE <br /> WATER CLOSET(TOILEI') � A/C—NHNDLG UNITS ' <br /> BATHTUB ; FORCED AIR SYSTEMS ; <br /> LAVATO"N(WASH BASIN) �_ HEAT PUMP � <br /> SHOWER ' UNIT HEATERS <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS � <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CIOTIaES WASHER � WOOD STOVE � <br /> URINAL � METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN i �'IFtPLACE INSERT(WOOD BURNING) i <br /> FLOOR DRAIN <br /> � liAS FIREPLACE ' <br /> BACKFLUW PREVENTERS ; GAS RANGE � <br /> SINK (SERVICE—BAR, ETC.) GAS PIPING _ <br /> � EXHAUST FAN � <br /> i <br /> i <br /> i � <br /> i <br /> � T <br /> 1 <br /> SUB TOTAL $ � SUB TOTAL $ <br /> PERMIT $ � PERMIT S � <br /> TOTAL FEE 5 ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSFTpACN RF/RSFTBACK SID£SFfBACN �LRNGIIECKNUMf1ER (EP PFCFIPiNO <br /> usE zor+e �oi eae� VAWNL$ITE FEES VALUA7'ION FEE <br /> —r-- <br /> ❑YES ❑ NO 9UIlDINf. <br /> IIEIGNi IIMITAtION NO OF OWELLING 512E OF gLUGRI <br /> IINIIG P�UMAING <br /> _ —_T_ <br /> pCGUPAhCY NO 0�Sif.ni�y OCCUPANI LOAD BASFMENt MFCIInNICAI <br /> 6POU� "_-- � -- <br /> ❑YES ❑ NO --- ' <br /> i <br /> ��DIIIONM.PtAN G��f.GK <br /> FlRESPRINKLERREO'D �Fr150N _ <br /> or��En ; <br /> FIREAIARMREO'D �F450V <br /> $iAIC!f1➢IUMG SIIRCI�4RGE <br /> TrcEorr,o�+sT r�nr+snrraovEnov CITYOFEVERETT runiir.woiiKs '� <br /> LOCAL SALES — — --�— <br /> oaTE TAX CODE IS 3105 TO7AL_ _ _ <br /> A��%�a.r�—.:- . .,.`-- -. . <br />�::. <br /> w;��.:, ,., - ' , <br />