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APPLtCATI�"^�'i FOR CONSTRIDC'[ 7N PERMIT <br /> CIN OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br /> /P/ROJECT A� JDDRESS: I D�I-I�R - I U I��2 SF /� <br /> �/�V�AI I K�U �\�l ��111) lO�o9-�D 4,� sc ��/C.e� TT�� 75o��r� lo�-L��n �3`� �,3a/� <br /> ovmea M�i�nooness cm nr rHor+e <br /> TENANT MAIIMOPC55 CIIY IIP PHOlIE <br /> ARCIIITECT OR OESIGNER MAIL AUORESS Gltt ]n` PHONE ' <br /> GENEf1�lLONTpAGTOf1 M�IL��JRESS GIY IIP PIIONE SfATELICENSE� <br /> MECNANICA�CONTFACTOR MAIUDDRE55 GTV ZIP PIIONE SiAiE LILENSE� <br /> �]�'1���� <br /> PLUMBINC CONIRACTOR 1AAIUDORE55 CI�Y 21P PHONE SUTE ULENSE• <br /> CONSRACT Pfj1 OF WORK <br /> �v HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br /> UESCRIBE FK AN�SOUARE FOOTAGE INVOLVEO GOHIACT PERSON ANO PHONE ND <br /> 1 F l �� , <br /> CONv�r�n l�73 /1/ f c (x s - /1' fi a <br /> OOK/i7 q , p )f �,{lfJ%FrQ I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPGSED USE O uaou+, APPLICATION AND NNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAl0E5CiiIPTIONOFPROPERTY�51iOWNBE:ONO%ATT�CHTWOCOPIES) tJOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or eiocK oF AUTiiORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE <br /> PEFFORMANCE OF CONSTFiUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOFK FOR WHICH <br /> APPLICATION �S MADE AND I COMPLY WITH THE STATE <br /> PMCEITA%LD.NUMBER CONTRAC ORS LAW 18 7 RCW AND 296200 WAC. <br /> y�n I p � /�- /g- �J' <br /> CONSTRUCiIONIOANLENDER,AUDRESS.TELEPNONENIIMBER X A / / Tl/n / -/M,/�I� /� <br /> SI('i�N URE DAtE <br /> CITY BUSINE55 LICENSE NO <br /> � PLUMBING MECHANICAL <br /> • .� NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> ' WATER CLOSET(TOILET) � A/C—A/HNDLG UNRS �— <br /> BATHTUB ; FORCED AIR SYSTC•MS ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNITHEATERS ' <br /> KITCHEN SINK&DISP i CLOTHES DflYERS i <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER ; <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) <br /> DFINKING FOUNTAIN ; FIREPLACE INSERT(WOOD BURPJING) � <br /> FLOOR D(iAIN � GAS FIREPLACE ' � <br /> BACKFLOW PREVENTERS � GFlSRANGE � <br /> —r— <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING <br /> � EXHAUSTFAN ' <br /> � ' <br /> � � <br /> � � <br /> � <br /> � ' <br /> SUB TOTAL E ; SUB TOTAL 3 /-'> <br /> PERMIT $ i PERMIT S /S' <br /> TOTALFEE 3 � TOTALfEE 3 _ 'J ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETUACK PEMSETBACK SIOESETBALk �lANG11ECNNUMI1Pf� !EF RFf.EIPiNO <br /> 53 ��7 <br /> usE Zot+E lOT�REA VACRNI SIiE FE[5 VALUATION FEE <br /> ❑YES ❑ NO � <br /> f1UtLOMfi j <br /> HEIGIIT LIMITATION NO OG OWELLING 52E OF 9LDGRI � <br /> UN11S P�IIMOING � <br /> T <br /> OCCUPANCY NO Oi5I0NE5 OLLUPANiLOAD B�SEMENT � <br /> GROUP MEC11aNIL�1 � _ <br /> ❑YES ❑ NO � <br /> FIFESPRINKLEfiREO'D �ERSON �D�IIIONnLPlANC11fCN � <br /> �� <br /> DIIIE� <br /> FIREAURM(iE0'D PEA50N <br /> STAIE OUIl01NG 511liLHAfiGE <br /> __ r— <br /> rvee or r,orcsr v�nNsarrnoven or CITY OF EVERETT runi ir,wonKs 1 <br /> LOCAL SALES — ---�— <br /> oaTE TA% COOE IS 3105 707AL � <br /> _ . ._...__.....� <br />