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APPLICATIO�I �O�i CONSTRUC��ONI PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> —. <br /> 3200 CEDAR STREET• EVERETT, WA 9g201 •259-8810 <br /> � OEMOUTION fl COMBINATION BUILUING f-'I MECHANICAL r� pLUMBING fl SIGN <br /> PROJEC7 ADDRESS %�OI � � � �' �"� <br /> OWNER � M��ILA�ODRE55 LIN IIP V HONE <br /> � �-'���--� . <br /> TE IT Mql AODRESS , FIION <br /> r�' �� �1 �� �r-���l��I����TY �� c.u�A , ��—�¢�3 <br /> AR HTF TOR ESIGN R Mpl pU0RE55 CIN ZIP PH01.E �j� <br /> R-SWII`l�-f l`�� ��Rf��t�( ����,t.o9 �/.�y¢�/�l /Z3 3f63 <br /> GENERALC NiRp�TOR pI�pDURESS CIT 21P FIIONE ` SiRTGLIL[NSE� <br />/ � <br /> MECH �ALCON�ACTOR^��qI�ADU 5 CITY 21P PIIONE rySTATE UCENSE� <br /> J / �,l�/ //�J <br /> y, ��� <br /> PLIJMSINGCONTRACTOR MAILADDRESS IiY IIP P ONE STATELI • <br /> ., � �lv yr� � � �,�'7�3 f� <br /> GO TRA T R�rEOPWORN 0���� <br /> ;JO HEATING SYSTEM: fl GAS �I ELECTRIC fl <br /> DE CRIBE Pn AND SOUr1RE FOOTAGE INVOWED CONTACT PERSON AND PHONE Hp. `//�/O, <br /> �/ / <br /> � < � (�a3 - 3 e� <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Paoros se �F em�oiNc APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT ALL <br /> PROVISIONS OF�.AWS AND ORDINANCES GOVERN�NG THIS TYPE OF � <br /> ''�LD SCRIPTIONOFPROPERTY(SHOWNBEIOWORpTfqCHTWOCOPIES) WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> , NOT. THE GRANTING OF A PERMIT DOES NOT FRESUME TO GIVE <br /> � e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL 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 MADE AND I COMPLV VJ�TH THE STATE <br /> PMCELTA%I.D.NUMBER CONTRACTORS LAW 1 .27 RCW AND 296200 WAC. <br /> CONS�RUCTION LOAN LENDEP,ADOPE55.TEIEPMONE NUMBER � /�r�`�S . <br /> /J <br /> — IGNATURE �iE <br /> CITV BUSINE55 UCENSE N0. <br /> . PLUMBING MECHANICAL <br /> NO. TYPE OF FU(TURE OR ITEM FEE NO. TYPE OF EDUIPMENT FEE <br /> • WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. � <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.7.U. 141 � <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS <br /> DIS'rIWASHER � VENTIlA710N FAN ?— <br /> LAUNDRYTRAY ; RANGEFOOD � <br /> CL07HES WASHER � WATER HEATER , <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR, ETC.) � GAS RANGE , <br /> . ; GAS PIPING � <br /> �-� i EXHAUST FA(J ' <br /> � <br /> —,—. <br /> i , <br /> _ 1 ' , <br /> � <br /> T <br /> SUB TOTAL $ ; SUB TOTAL $ ' <br /> � <br /> PERMIT $ i PERMIT $ i <br /> TOTAL FEE $ � TOTAL FEE $ �— ' <br /> FOR OFFICE USE ONLY: <br /> fRONT SETPACK REAR SFTBACK SIDE SETBACN P��N CIIECK Nl/M9E%� FE�[ '�� RECEIPT NO. <br /> 3 � <br /> usezoNE �ornnen VACANI517E FEES V4LUATION FEE <br /> f lYES I1 NO BUILDMG 1/�� � � <br />� /C� i <br /> HEIGMTpMITATION NOOfUWELLING £IZEOFBLOGRI <br /> UNIiS I I � , <br /> PLUMOING <br /> 'ANCY NO M StORiES pCCUPqNT LOAp BASEMENT MECNnNICnL � <br /> ��,,,�,6 � 3 � <br /> fIYES � 0 � � <br /> F.p ��AqMREO'D RFASOY �DD�11pNPl.t'L�NCII@LN �—� <br /> N0 on�En -�— <br /> FIRF SPRIN�NIE1R PEO-D RF�FON i i <br /> /VJ �S�iE�1lilDl^lGSURCIUf1G� i � <br /> TYPE OI'f:ON$i p�ANS M{+p0 Ij BY -- LLi% <br /> (� CITYOFEVERETT rutur,wonKs <br /> V_ A � � �/� LOCAL SALES ___�_ <br /> /V on,e _ TAX CODE IS 3105 7o7A� ; <br /> � <br />