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APPLICATIV�1 FOR CONSTRUC7 .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOUTION �' COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: �j/O <br /> �,�o�a�t� �C�/6�, �� 9 zo / .zs/-v.�.�-� <br /> OWNER MAIL�DDRE55 LITY 11P PNONE <br /> l?,o�.�- .7/l' /-r�1�J;� .�3�,Z T L'o�Gy /:�ric/� G�//� <br /> TENhrii ,,/i.iFiiwuuFtJb � CIlY IIP p1�ONE - � <br /> �(l��/ ti//S.SdG ��C'-d�f/�`Li <br /> ARCPoTECT OR S�GNER M�II�DORE55 FIfY �IP PHONE <br /> s/<o�dirL .�r�� ��/,G,, ��.r.s' �c�t � s'=r y�s'� <br /> GENEIUICONiRAGI0f1 MML/�WRE55 �IIY pIP p110NE SI�fEIICENSE� <br /> s__'_ <br /> MECNIINICAL CONTR�C70R MAIUODRE55 (IlY pIP PqpNE STATE UCENSE� <br /> PLUMBINGCONTRI1CTOf1 M�ILADDRE55 GiY zlP pNONE STATEUCENSE� <br /> CONTMCiP{qCE NWUF// <br /> 9�e.�� 00 � HEATING SYSTEM: (�'GAS ❑ ELECTRIC ❑ <br /> OESCPoBE qSWAREFOOTAGEINVOLVEO � ` CONTRGTP[RSONANDPNONENO <br /> � r r-re�— /-',n�sk/ 0,�,1 <br /> �O.�J <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> vnoa0se pv eutprxi APPLICATION AND KNOW THE SAME TO BE TRUE AN�CORRECT ALL <br /> �� `.�_ PROVISIONS OF U1WS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HERE�N OR <br /> iecµoesc�nvna+oFrRoaenn�s�awNee�owaa rt�cNTwoe es� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior��ze�ocK�oF ��`� �� ���P�'� AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGUUVING CONSTRUCTION OR THE <br /> PEflFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PHOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCEL TAIt I.D.MIMBEH CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTONIO�NLENOER.A00RESS.TELEPIqNENUMBEN 5 ATU�/� �/�/ .' - / �T//��� <br /> Cltt BU9NE55 UCENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> � NO. TYPE OF FlIfTURE OH ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILE� � q/C—A/HNDLQ UNfTS � <br /> BATHTUB ; FORCEDAIRSYSTEMS ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP i <br /> SHOWER � UNIT HEATERS � <br /> KITCHEN SINK 6 DISP ; CLOTHES ORYERS ; <br /> DISHWASHER � RANCaE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER ; <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL � MEfALFIREPLACE(WOODBURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR ORAIN � GAS FIREPIACE � <br /> BACKFLOW PHEVENTERS ; GASRANGE ; <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING � <br /> ' IXHAUST FAN <br /> SU8 TOTAL S ; SUB TOTAL S ; <br /> PERMIT S � PERMIT S � <br /> TOTAIFEE S � TOTALFEE f ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSET611CK RE�RSETB�CK SIDESETB�CN PUNCIIECiNUMBEII fEF /�/ �ECEIPTNO <br /> �/� <br /> / <br /> lISE20NE ior�n¢e vecu+isrte EES VAIUATION FEE <br /> ❑YES ❑ NO OVIlDIN6 � <br /> NEIGHTLIMITATION NOOFDWEIUtM S�ZEOFBIOG/fl � <br /> UNIfS ��j/�� -]�'• pLUM01NG � <br /> ui-/ ! � <br /> OC�CUVPANC� 1q0i5i(W[5 WCUPANTLnO�O B�SEMENT MECN�NIC�I � <br /> / .I. (J .I• �ES ❑NO � <br /> FIRESPHINKI_F,RflEO'0 �FASON //-� �DWOONMPI�Np�fCN � _ <br /> ll% CY ' � <br /> o�NEn <br /> FIREAVJIMqEO'D RE�SON � <br /> 4(�� � <br /> {.�/ L,l SIqEOWIDINOSUPLN�f16E —_ i�' <br /> V/ ! �' <br /> TYVEOFf.ONST FlANSA�!��OVEDOY CITVOFEVERETT �uB11f.WOPNS <br /> � � ���!� LOCAL SAI.ES --'-- <br /> \/1 ( <br /> D�TE � TAX CODE IS 3105 TOTAL � r �<<:� <br />