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APPLICATI�, ] FOi; �ONSTRUCT. JN PERMIT <br />CITY OF EVERETT • BUILOING DIVISION <br />3200 CEDAR S � REET • EVCRETf, WA 98201 • 259-8810 <br />� DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: �V 3� �_,�'� A,l,� S�, _ <br />�E���--�"�-��-- <br />OWNER MNLe00nEc5 Ci1Y zN P��oM1 <br />.5'�.v,�, A�rc No�+� �r•S t� t_ _� z io �f� cv; � r' vL S'u„�'a ?ioT —,� �d,t �.v SS'zu i <br />IENFNT MML/�DOlI[55 GITY TIP PIIpNt —� � <br />1}'b/�'1�'- <br />ARCHITELTORUESIGNER M�It.WOf1E55 Gltt ]IP PHONF <br />GENEMICONIf1eC7IXi MAILADDRE55 CItY IIP PHO . AiE C NS � <br />��Av�r,d�f x :��3 u��.�rMaNTI �vc; �� /��� �r,. n� cJ� ,vo,r .�r. yk,� ,2 =_ — <br />MECNANICl�LCONTRRCTOR MAILADD(1E55 r.itt ^m PII[�SLQELILENSE� <br />PWMBINGCONTR�CTOR 6:.4LADDRESS CITY ZIP PI�ON'c 5'AIELICENSE• <br />UESCRIBE WORN �NO SOU�PE FOOT�GE INVOIVED <br />PRO{'pSE� USE Oi BUILOING <br />IEGAL OESCRIPTION 04 PROPERTY �SHOWN BELOW OR ATfACN TWO COPIES� <br />l0T BLOC1c OF <br />P�CI�OLi�f�NUMdER J� JG C./ /C / <br />/� <br />CONSTRUCTI(klLOANLENDEF,AC�RFSS.TELEPHONE NOMBEA <br />PLUM8ING <br />NO. TYPE OF FI%TURE OR ITEM FEE <br />WAIER CLOSCT(TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SIW'< S DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />U�INAL <br />DRINKING FOUNTAIN <br />FLOOfi DRAIN <br />BACKFIOW PREVENTFRS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL $ ' <br />PERMIT S <br />I TOTAL FEE S �—', <br />FOR OFFICE USE ONLY: <br />FfiONTSETB�CK RERP SETBACK SIDE SETB�CR <br />USE ZONE LO* AiEA V�C�N/ SIIE <br />DYES ❑ NO <br />HEIGIIT LIMITATION NO OF �WELLMG $12E OF OIOGRI <br />UN17$ <br />OCCUPANCY I NO Of SMai[5 OCCUPRNf <br />GROUP <br />FIRESPRiNKLERREa'D i1FA50N <br />FIRE ALARM REO'� AFRSON <br />•rPE <br />_—� <br />APPROVED <br />❑YES ❑ NO <br />HEATING SYSTEM: ❑ GAS ❑ EIECTRIC ❑ <br />CONTRCT PEf1SON �NU PHONF. NO <br />I HEREBY CERTIFY THAT I HAVE REA� AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT AlL <br />PROVISIONS OF LAWS AND OROINANCES GOVEfiNING THIS TYPE OF <br />WORK WILL �E COMPLIED WITH WHETHER SPECIFIED HEREIN OA <br />IJOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PrIOVISION OF ANY <br />OTNER 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 COMPLY WITH THc STATE <br />CGNTF OR�'., LAW 1 2i-R W AND 296.200 WAC. <br />�� � r � � <br />SIGNRIIPE DAiE <br />CITY FlUSINGSS UCENSC NO <br />MECHAkICAL <br />N0. TYPF.OF E�UIPMENT FEE <br />ryV— ...�VLUUIYIIJ <br />FORCED nIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />WOOD STOVE <br />ME'AL FIREPLACE I <br />FIREPLACE INSERT <br />SUB TOTAL 8 <br />PERMIT E <br />Pl�NC11ECKN11MOFf1 IfEF IfIfCF�PTHO <br />i �i2�:� <br />OUII DING <br />Pl11MUMG <br />MECMnNILAI <br />/•OOIfIONII. PLAN CIIlGN <br />Otll[q <br />St�tE �U�lOiHG SIIRCIInnCE <br />CITYOFEVERETT runiicwonKs <br />LOCAL SALES <br />TAX CODE IS 3105 ioiAL <br />� <br />