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- -----��. <br /> /�PPLICATIG J FOR COWST�iUCZ_ jN PEE;MIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETf, WA 98201 •259-8810 <br /> O DEMOLITION ❑ COMBINATION ❑ BUILDING L� MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJEC7 AODRESS: �� � � S L� 3 r"�� ` � <br /> , <br /> 1lenr �' Dc��:- �-;s��e✓ C_ve�r.�tt �rE�.���I � �i - � ia �- <br /> OWNER MAILAWt1E55 Cltt IIP PNONE <br /> IENANT MMl�00Rf55 f.I1Y liP p110NE <br /> ARCHRECTOHDESIGNER M�II I�DDf1E55 CITY )IP PHONE <br /> GENERAICONiReCTpI I MAILAODOESS ` �itY riP PnONE SI�7EIICENSE� <br /> ���5 1-�E'uT.'�,c, S`��C=. Yvw�r 5i, f�'�.cw��ro� �ifT�7� 7`i�/- 7�;Cii� <br /> MECNANICALCONfRA�TOR MAILaDORE55 CITY ZIP p110NE S7AiELILENSE• <br /> IPLUMBIyGCONiHACTOR MRIIADDRE55 G11V 21P PIIONE STAIEUCENSE• <br /> � �o , �/'JU <br /> CONTqACT PPICE OF YIORK <br /> HEATING SYSTEM: �GAS L� ELECTRIC ❑ <br /> DESCNIBEWORKANDSOUAR�fpoTAGEINVOIVED CONLACiPEfi�SqN�HpPNONENO <br /> fewv,r„r � f� IeC�✓,' � ��rr�<« �� r�l✓co -�.� i c��. �Sy- 7�G� <br /> G'�� T �`- <.A��' � . �� C �– � iei � - v.c� <br /> 1.� W �� I H�REBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILOING APFLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS APJD ORDINANCES GOVEFNING THIS TYPE OF <br /> WOPK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAlDESGRIP710NOFPPOPERTY�S110NTlBELOWORA77AGHT4000PIES) NO7. THE GRANTING OF A PERMI' DOES NOT PRESUME 70 GIVE <br /> �ot BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATF OR LOCAL LAW REGULATING CUNSTRUCTION OH THE <br /> PERFORMANCE OF CONSTRUCTION. THAT i AM AUTHOR�ZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPI.ICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCELTA%t.�.NUMBER CONiRACTORS LAW 78.27 RCW AND 296.200 WAC. <br /> _ .� C� � � /� <br /> l � <br /> CONSTRUCTION LOAN LENDER,A�DRE55.TEIEPHONE NUA�BEfl x/>� �� �y�%� 9"u�(�� •�`-�'W <br /> SIGNATUR DATE <br /> CITv OUSWESS LILEfdE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUFE OR I�EM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATEFl CLOSET(TOILET) � A/C—AMNGLG UNRS � <br /> BATHTUB ; FORCED AIR SYSTEMS ' <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNIT HEATERS � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS ' <br /> � <br /> DISH WASHER RANGE Fi00D � <br /> LAUNDRY TRAY ; WATER HEATEF ' <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT(WOOD BURNING) i <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> _ BACKFLOW PREVENTERS � GASRANGE � <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING <br /> ' EXHAUSTFAN <br /> � ; <br /> � , <br /> � � <br /> � <br /> � <br /> —�— <br /> SUB TOTAL E � SUB TOTAL E �Q ; <br /> PERMIT S � PERMIT $ �— <br /> TOTAL FEE S � TOTAL FEE S ,Y'.j � <br /> c <br /> FOR OFFICE USE ONLY: <br /> FRONT SETAACK PEAP SF.TBACK SIDE SETB�LN PUN CIIECK NUMO[R FEF fiELEIPI NO <br /> u5E zoNE LOI�qEA VFC�Ni SIiF FEES VAIUATION FEE <br /> - �YiS ❑ NO pUIIDING <br /> NEIGIITLIMITATION NOOFOWELLING SIZEOFBLDGRI <br /> UN17S <br /> i'LUMOING <br /> OCCUPANCY NO Ot510R1E5 OCGUPANTLpAO B�SEMENT � <br /> GROUP MFf,HANIGPL <br /> rJYES ❑ NO - � <br /> i <br /> FIRESPRWKLERREO'D �1EASON ApDIIIONAIPLRNCMF.LK � <br /> OIHER <br /> FIREAfAPMREO'0 RF�GON � <br /> $TAIE DUILOW6 SURCM4fi[E <br /> TYPEOFf,ONSi PLAN3APVflOVEfIPV <br /> CITY OF EVERETT runur,wonKz <br /> LOCAI.SALES — — <br /> �p,E TAX CODE IS 3105 70TA� <br />