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APPLICATIL.� FOR CONSTRUC7 .JN PERMIT <br />, CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-BB10 <br /> I9�TP.�I'/Mp�/�.p� <br /> O DEMOLITION � COMBINATION ❑ BUILDING Q M�Z`HANICAL ❑ PLUMBING ❑ �IGN <br /> PROJECT ADDRESS: �Q����11'F!/P�fil� �E <br /> J!M �_3S�!l¢ <br /> I OVYNEH M �DOi1ESS GITY ZIP PHONE <br /> 2�1 9 c� -����✓.�'f:-�''�- ��-���Q' 337 ��� <br /> IENANT MMIAtId1E55 f.ITY IIV PIIONE <br /> %:;'��/1"c���1rtS[_,��1�'�= �43�I�yP�uo a'_�n- 9�� �✓37393 <br /> 11f1C1NTEC70RDE51GNER AWI�ODRE55 CITV 71P PHONE <br /> �@g�xve����t�r i�r�f-ti.c��ro,s� �ws�.��y��z2_� ���x17�L_. <br /> GENEML CONTR�� MNL MDRESS CITY Ilf` PNONE Sf�TE IICENSE� <br /> r _ �� ,n1.�1��z/2l�fL g.E�yaSf�T �i'B2�?��382//4�PFNG O 3 <br /> MEC/UNICALCONTR�CTOR MAIIADDRE55 Cltt ZI� PHONE STA7EUCEN � <br /> N/t <br /> MUMBINAG�CONTRACTOR MIULADOAE55 CITY ZIP PIIONE $TATE LICENSE� <br /> /-� <br />' CqNTMCT PPoCE O�WORR <br /> r HEATING SYSTEM: GAS ❑ ELECTRIC O <br />� OE !E Wa11N AND SOU�RE FOOTAGE INYOWFO CONTACT PERSON MID FIKKlE NO <br /> � <br /> ��� SH"N.B ��J��v�y3 �'!� <br />� I HE7EDY CENTIFY THAT I HAVE READ AND EXAMINEO THIS <br />� � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> ►novoseo use oF e�n�drxi PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPE OF <br /> �FIG�1 WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> lE�}A�pE$CRIP1pNOiPROPERTYI�p�����MTT/iCN7W000%E5) NOT. THE 6RANTINQ OF A PERMIT DOES NOT PRESUME TO GIVE <br />' io��_��K�_�s AUTHORITY TO VIOLATE OR CANCEL THE PqOVISION OF ANY <br /> OTNER S7ATE OR LOCAL UW REGULATIN6 CONSTRUCTION OR TME <br />� Tx���+ PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF TNIS PHOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PNICE,TA%I.U.IAMBfN CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> �� � � �� /�" /A' A �/'� / <br /> CpNSTpUCl10N LOAN LENDER.AOORE55.TELEPMONE NIIMBER y��� T/l A l _`�K/�(O <br /> 9ff, A RE � � O�TE <br /> I <br /> CI7Y BUSNESS LICENSE NO. <br /> I <br />. p�p��� MECHANICAL <br /> N0, TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMEHT FEE <br />�� WATER CLOSET(TOILEn � A/C—AMNDIO UNR3 ' <br /> I � BATHTUB ; FORCED AIR SYSTEMS � <br />�i� UVATORY(WASH BASIN) � HEAT PUMP — � <br /> SHOWEH ' UNIT HEATERS _y _ <br /> KITCHEM.^,INK 8 DISP � CLOTHES DRYERS _T_ <br /> � DISHWASHER � RANGEHOOD __ ' <br /> � LAUNDRYTRAY ; WATER HEATER j � <br /> CLOTHES WASHER � � WOOD STOVE % � _ <br /> URINAL ' METAL FIREPLACE, OOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT pNOOD BURNING) � <br /> FLOOR DRAIN ' � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; GAS RANGE � � <br /> SINK(SERVICE—BAR,ETCJ .�' � GAS PIPIN ' <br /> � � EXHAUS FAPJ ' <br /> � ' � <br /> � ' <br /> � ; <br /> � .— <br /> � /�/ SUB TOTAL S � SUB TOTAL f ; <br /> PERMIT S i __ PERMIT f � <br /> TOTAL FEE S ' ',t7TAL FEE E ' <br /> FOR O�FICE USE ONLY: � <br /> FIIONT SETBACK AEAR SETBACK SIOE SETBACN PIAN CIIECN NUMBER FEF .-n pECFIPT NO <br /> 2�' d� ��` — <br /> USE iONE lOT�REA VAC�NT SITE FEES !'ALUATION _ �EE T_ <br /> ❑YES ❑ � � <br /> BUILOINA � <br /> MEIGNT 11MITATION NO OF OM/ELUN(i S�ZE OF BIDGR.I � <br /> UNIT$ ;� L� P�UMBING � <br /> T <br /> OCCUPANCY N�O�SI(Wf5 OCCUPANTl0�0 B�SEMENi MECN�NICAI � <br /> OHOUP _ � <br /> ' I� `�/. ❑VES �Mn i <br /> FIRESPRI,NK'^LERREO'D REASON �0��710NALMANCIIF.CIc i _ <br /> /� ' <br /> pTNER <br /> FIi1ERURMREO'D REASpN � <br /> �p $TAIE BWl01NC SURCII�IICE —_ �� <br /> /uY r <br /> TYPE Oi f,ONST PL�NS APPROVEO flY CITY OF EVERETT ���91 If,WOPN: � i <br /> ��I LOCAL SALES -- — � <br /> � o�TE (� TAX CODE IS 3105 7oTAL _ � �� <br />