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�— <br /> APPLICATI�..J FOR CONSTRUC7 .JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br />� 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COM8INATION ❑ BUILDING �1 MECHANICAL ❑ PLUMBING p SIGN <br /> PROJECTADDRESS:�7/S /S� Sf FU�rt � �,qva <br /> �Ue fG� �o � �'�iT�orr� 3/D'7 (�y-��C`r-. �—t� �j.f��U� �Q� — l/'Jr j <br /> I OWNER �MRILAppPE55 CITy� ZIP PMCNE <br /> L <br /> TENANT NqL�D �C55 CIIY )IP PHONE <br /> 13 �J !� �{zo� t�,H�' flU� ���rtH �Jc� �,tzo3 �s�i- oB�S <br /> ARCNRECT08 ESIGNER M�I ORE55 �Itt ]iP PMONE <br /> �(�SSz.� �'c�nS-4. 4s(o7 I'S3'�Av�N.F Rcd�•+caJ I�g �6oSZ ( Zat,.) Slacl '3$5'Z <br /> GENEMIGONif1A�TIXi MAILpD0�ES5 CIiY DP PIIONE $UiEIIGENSE� <br /> Ro���' L�,���Sb�-i�l+l �?0. 8ax3o7 ���,,,J,.N�e 02 97351 <se3)y38-38k.� <br /> MECN�NICAICONT CTOR MAIADOf1E55 CITY ZIP PIIONE S7AiEUCENSE� <br /> PLUMBINGCONTRAGIOR MnILADDf1E55 CIiY ZIP PHONE SiA7ELICENSE� <br /> GONiRAGT PRICE OF WO�rc <br /> 3C 3 (� � HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> OESCRIBf WORN AND SOU FOOTAGE INVO VF. CONTACT PCRSON AHD PHONE NO <br /> s . �,5-i�.9� ,K� Nu�+c S �w, <br />' I HEREDY CERTIFY THAT I HAVE READ AND EXAMINED TH�S <br /> PROPOSED SE OF Bl11iDING APPIICATION AND NNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND OROINANCES GOVERNING THIS TYPE OF <br /> ma� �'" � WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�LDESCIiIPTIONOFPROPERtt(SIIOWNBELOW�O,!qATTAGNTWOCOPI 5� I � � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCN � or�1r�� �Ia'�' o� T�G.�! AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ���I�� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION �S MADE AND I COMPLY WITH THE STATE <br /> PMCELTA%I.D.NUA BER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> :ONSTNUCTION LOiV1 LEN ,��DRE TELEPNONE NUAIBER X l�jy(.l��I�.Lu'^-- p�M�l II-S S'� <br /> SIGNATIIfiE DATE <br /> CITY BUSINESS UCENS[NO <br />� PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURF.OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> I WATER CLOS2T(TOILET� � A/C—A/HNDLG UNRS � <br /> II BATHTUB ; FORCEO AIR SYSTEMS ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � �2 UNITHEATERS � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS � <br /> DISHWASHER � MNGEHOOD � <br /> IAUNDRY TRAY � WATER HEATER ; <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL � ME�'AL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT(WOOD BURNING) i <br /> FLOOR DRAIN � GAS FIR[PLACE i <br /> BACKFLOW PREVENTERS ; GASRANGE ; <br /> SINK(SERVICE—BAR, ETC.) � GAS PIPING <br /> � 3 EXHAUST FAN ' <br /> � <br /> — ' <br /> � � <br /> — i � <br />� � <br /> SUB TOTAL E ; SUB TOTAL S .2 O ; <br /> PERMIT $ , PERMIT S /5 � <br /> TOTAL FEE S � 70TA1 PEE S 3�' ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBAf;N REAA SFTBRCN SIDE SE781CN �UN GIIECK NUMOFR FEF �Ef.FIPi NO <br /> 3y�s <br /> u5E zONe ior hnen V�CANT SIiE FEES VALUATI011 FEE <br /> ___ OYES ❑No owioiNr <br /> MEIGHTUAt4ATI0n NOOFOWEILING SIZEOFBLDCRI <br /> UNIfS P�UMUWC i <br /> � <br /> OCCOUPANCY 1 `Of SIONES OLCUPANi tUAD �ASEMENi yE���qN1�A� � <br /> ❑YES ❑ NO — <br /> FIRESPflINNLERREO'D �EASON AODIIIONALPIANC��6CN i <br /> O111Ef1 ' <br /> i <br /> FIFEAIAflMREO'D RE/•SON --�— <br /> $TA[OUIL�WG SUIiC11At7GE <br /> f <br /> TYPEOFf,pNSI PInNSAPPlIOVEDOY CITYOFE\�ERETT �IIBIIf,WOPKS <br /> LOCAL SALES --'— <br /> catE TAX CODE IS 3105 70TAL <br />