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1 <br /> 'r.� A <br /> APPLICATIO.� FOR CONSTRUCTIJN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-BB10 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILD�, ❑ MECHANICAL C PLUMBING ❑ SIGN <br /> _ ��/O -?�5 x� � <br /> AROJECTADDRESS� �-- _ 'z ����,� STn �� T ( 3c,id - �-s-- <br /> Vt2H�,� N9�.(_ � `��6� - �i%_� 5:2�+� T , 5T.3-n� �ve� �l�� t,v�9- 9��iZ. 3�o -4Sa-2e6Y <br /> OYMER MNL�OONE55 CI IIP PIIONE <br /> �tJ D. KJ .� <br /> TENNIT 1INI.ApORC55 f.ITY /IP PIIONE <br /> S = Lr <br /> AqC111iECTORDE5IGNER MIIIIADORf55 ��n' 7��` PHONE <br /> �J'L''�. l� ' <br /> GENEMIGONTpALTOH M�ILAO�f1E5S CIIY IIP � PIIONE SUTELICENSE� � <br /> MECNIWIGwiCONTRACTOR MAILADDRE55 CITY IIP PNONE STATELICENSE� <br /> � PLUMBINGCONTRACTOR MAIL�DDRESS Cltt ZIP PHONE iTATEIICENSE� <br /> i � LONTMCT PRICE OF WpiN <br /> �j g� c�� c, NEATING SYSTEM: �GAS ❑ ELEC�RIC ❑ I <br />� DESCRIBEWORNANDSW�REfOOTAGEINVOWED CONIACTPGRSONANDPHON[NO � <br /> � t.�� si — R�cN4/Gni ia,vri,r � .�,s�t 652 -2��(0� i <br /> ' � n1:�cv /3r�3 T.SL � �K T i .v l'� & r+-i ie��' T S..r4 _ �.. <br /> I , I HEREBV CERTIfY THAT I HAVE READ AND E%AMINED THIS � <br /> �ni �,o tv�� i=G o.a�2 — APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORHECT ALL <br /> �. PROPpSEDUSE OF BUILDIN6 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> I �GU c L L /�lf �ry WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> IEG�L0E5CRIPT10oN�OfPROPERTY�S110NR1BELOWORATT�CMTYIOCOPIES� NOi. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />� �oT y"�� o eiocK � 7� ov AU7hi0RITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> , a�� OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE <br />� P[RFOHMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOH WHICH <br />' APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> VMCELTNt1.D.M/MBFR ` CONTRACTOflS LAW 1827 RCW AND 296.200 WAC. � <br /> 'ZC��-.`� � -�`� Q/ � D v J� `7 <br /> ClklSTRUCTION LOAN LENDER.AD�RE55.TELEPHONE hJMBER X��_ "� \ ����/ <br /> ' C/2p gs/� �¢ti;�/) /N j�—� SIGN�IURE DAT � <br /> y ' CITY OUSINE55 UCENSE NO <br /> j i PWMBIN6 MECIIANICAL <br /> p � NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> . WATER CLOSEY(TOILET) � A/C—AMNDLG UNfTS ! <br /> BATHTUB ; FORCEDAIRSYSTEMS �_ <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> - SHOWER ' UNITHEATERS ' . � <br /> ' KITCHEN SINK 8 DISP ; CLOTIiES DRYERS � <br /> DISHWASHER � RANGE HOOD � <br /> � LAUNORY TRAY ; WATER HEATER � <br /> � CLOTHES WASHER � WOODSTOVE <br /> URINAL ' METAL F�REPLACE(1NOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> � FLOOR DRAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; GASRANGE _ � <br /> SINK(SERVICE—BAFi,ETC.) GAS PIPING � <br /> � IXHAUST FAN ' <br /> � ' <br /> � <br /> � � <br /> � ' <br /> i ' <br /> � ' <br /> SUB TOTAL E ; SUB TOTAL S ; ' <br /> PERMIT 5 � PERMIT S � <br /> TOTALFEE S ' TOTALFEE S ' <br /> FOR OFFICE U3E ONLY: <br /> LRONT SETB�CK RE�R SfTB�CK SIDE SETB�CN PI FN CIIE��NII�I�FR ,/ �E�`�/ , ^ NECEIPT NO <br /> J� /�% ci <br /> usE ior+e/J � �J iot�a¢n vee�r+t sire _ FEES VALUATION FEE <br /> /Ci (/ _ ❑ves ❑ No nunni���: r3 l7�CJ 22 ' — <br /> � <br /> MEIGHT LIMITATION � NO OF OWELLING SIZE OF BIOGRI ' <br /> UNITS X SZ�U Pl11MOWC. -- ' <br /> 1 <br /> GCCUPANCY NO 0�SIONES OCCl1P�NT LOAO BASEMENT MEf,11nNICnI � _ <br /> � I YES ❑Nn --- ' <br /> AI)UIIIUNII PI�NGIlf,N i <br /> FIRESPRINKLERHEO'0 �7Fn`ON _ — <br /> i <br /> O1r1E� <br /> FIPEALARMREO'D RE�CON � <br /> SIAI[OIIIl�I11G9111.:11MGE —_ � h/f <br /> } ��� <br /> TYPE Of f,ONST PL���S�PPf10VE�OY CITY OF EVERETT �IIfl11f,WOPnS , - <br /> LOCAL SALES ----'— —"�— <br /> �— UAfk�Z� TAX CODE IS 3105 TOTnL � <br />