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�. -- <br /> APPLICATIOr�r FOR COI�OSTRUCTIVN PERMIT <br /> CITV OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITfON ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PRWECT ADURE::��: <br /> OWNEX M/uLA00RE55 CIT' 2�� PHONE <br /> TENANT �L/�DDRE55 CITY Z�P PHONE . .. <br /> �RCNITECT pi DESIGNER MNl AOIX1E55 CITY liP PHON'c I <br /> L t�_ i/���r��� �o�i� Ev�-e�,e.�-�N w�� 9��0� 2yo-iQis «VE1�Z�DGy.DS ' <br /> GENENALCONTMCTOR M/�IL/�DDRESS G�Y IIP PRONE $GTEUCENSE� <br /> MECNANICQCONTFACTOR M�ILADORE55 LITY ZIP PIIONE STATELICENSE� <br /> PLUMBINGCONTPACTOq MAILADORESS CITY Z�P PHONE STQELICENSE� <br /> CONTflACT PRILE OF MA711K ^� <br /> a HEATING SYSTEM: O GAS ❑ ELECTRIC ❑ <br /> ' DES^.RIEE WORNANU SOUARE FOOiA6E WVOIVED CONT�CT PENSONANO GMONE NO <br /> ' STo�c�C s � 4��� �v 29o-i8i8 <br /> - ZSS 5 I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> . vnoroseo usF oF euuar+a PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF � <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> , �cµpescn�rtip�pF rrqr�prv(yqwN e¢�owaq� m�oriesl NUT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � 1O7�_&� � � ' (p AUTHOPITY TO VIOLATE Oq CANCEL THE PROVISION OF ANY <br /> OTHER STATE OA LOCAL lAW RE6UUITING CONSTRUCTION OR THE � <br /> � 2�{�y fL SG EV�G PERFORMANCE OF CONSTRVCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICAT N IS MADE AND I COMPLY WITH THE STATE <br /> PARCELT/JI I.D.NIIMBCR CONTR ORS W 18.27 RCW AND 298200 WAC. � <br /> CONSTRIlC110N IO/iN IENDER.�DdiESS.TELEPIIONE NUMBER ` CY � / � <br /> • IGN�TURE �TE <br /> � ' CITY DUSINESS IICENSE NO. <br /> � � � PLUMBING MECHANICAL <br /> � - NO. TYPE OF Fl7(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � � WATER CLOSET(TOILEn � A/C—MiNDLG UNfTS ' <br /> BATHTUB ; FORCED AIR SYSTEMS ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> � SHOWER ' UNITHEATERS ' <br /> � KITCHEN�LNK 8 DISP ; CLOTHES DRVERS � � <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOU STOVE � <br /> . URINAL ' METAI_FIREPLACE(WOOD BURNINCa) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> � FLOOR DRAIN � GAS FIREPLACE ' <br /> � BACKFLOW PREVENTERS ; GAS RANGE � <br /> ' SINK(SERVICE—BAH,ETC.) � GAS PIPING ! <br /> . � IXHAUST FAN - <br /> � ' <br /> � <br /> � ' <br /> � ; <br /> � � <br /> SUB TOTAL S ; SUB TOTAL f � ' <br /> PERMIT S � PERMIT S � _ <br /> TOTAL FEE S ' TOTAL FEE S- ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSE7BACN / AEARSF.TBACK / SIUESET9ACN PLANGI���/ fEF �� RECEIPTNO <br /> �fn <br /> us¢i� � IOT�REA VACANTSITE FEES VALUATION FEE <br /> i ❑res ❑ rvo eunnwc 3 �UQ ' C/ <br /> NEIGNT UMITATION f MO OF U'MELUN(3 SIZE OF BLDGRI � <br /> Z � UNIiS Z�a C`� PLIIMIIING + <br /> J i <br /> OCCUPANCY NO Oi SIMtlES OCCUPANT LOAD BASEMENT MFCM�NIL�I � <br /> i <br /> G �I � ❑YES O � - <br /> RDOIIION�I.PUN GHF.LN � <br /> FlHESPflINKLERflE�'D AE�SON � - <br /> � <br /> O7MER i <br /> FIREAURMflEO'D AE�S(N1 —_ � <br /> STn7E BU�lOiNG SUnGN�qGE � <br /> TYPE OFf,ONST PLANS�PPAOVED BY CITY OF EVERETT PUfl11f,WORNS �~- . <br /> �oca�sa�Es —'� <br /> / DATE 7 Z/ 9 TAX CODE IS 3105 TOTAL - <br />