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APPLICATIO►. FOR CONSTRUCTI -jN <br />PERMIT <br />CITY OF EERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-88I0 <br />❑ DEHC LITION 11 COMBINATION p BUILDING ❑ MECHANICAL <br />PROJECTTGADD/E!SS: <br />❑ PLUMBING ❑SIGN <br />owrFn 915- � '° <br />M <br />Il ADDRESS <br />ary <br />n/ <br />('^ �Z rlr ¢ nlonE <br />si�y�r rl a ('lug 1ENANT <br />MMI ADDRESS CITY TIP PNCNE <br />—/Y�yLL�1, •,�I P� IE,� l nU .tea ✓ ,. Q <br />AIA/;/Po��![�c r�O�/n-DEsimlEn MADORE $ <br />CITY ;B <br />E1'MI <br />_1L- L/ I7 Pll A/L (1 ��C /�(,•Y r� � PHO�N•NEE <br />GENF.nALCONIRA I MAIL ADDRESS 4' <br />— <br />�y{y7.^� <br />CITY Z r{/-`�ri PnOUNE <br />J 5-�111E IICFNSE F <br />MECIIANICAI CONTRACTOR MAIL ADDRESS Clry --__ <br />IIP <br />PHONE <br />STAiF "TENSE 1 <br />PLUMBING CONTRACTOR MAiI ADDRESS CIIY is <br />PHONE <br />_ <br />STATE LICENSE 1 <br />CONTRACT PRICE O WORK _ <br />07,`-V <br />DESCRIBE WORK ANO'SOUAnr -DOTAGE INVO`VED <br />HEATING SYSTEM: ❑ GAS <br />❑ ELECTRIC ❑ <br />ri. II 1 1� <br />CONTAC r PERSON AND PHONE No <br />�1 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMIN: THIS <br />APPLICATION AND KNOW THE SAME TO RE TRUE AND <br />PROPOSED;USEE <br />�CF_ <br />CORRLc T ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COIAPLIED WITH WHETHER SPECIFIED HEREIN OR <br />EEGAE DESCRIPTION ocr I+FnrY (WIUM HE OW OR An.c, Two coned <br />IOr <br />NOT. THE GRANTING OF A PERMIT DOE' NOT PRESUME TO GIVE <br />BLOCK or <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE <br />PERFORMANCE OF JONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK <br />FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.2 <br />PARCEL TAKID. NUMBER <br />RC AND 296.200 WAC, <br />CANSIRUCIION LOAN LENDER. <br />ADDPEss, TEIFn1oNE NOMnEn <br />1 _ _ / — q 7 <br />C� <br />LORE DATE <br />Y BUSINESS <br />110ENSE NO <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />MECHANICAL <br />— <br />WATER CLOSET (TOILET) <br />' <br />NO. <br />TYPE OF UOUIPMCNT <br />A/C—A/HN OLG UNITS <br />FEE <br />—�— <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />; <br />FORCED AIR SYSTEMS <br />SHOWER <br />HEAT PUMP <br />-�— <br />KITCHEN SINK 8 DISP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />" — <br />DISHWASHER <br />' <br />RANGE HOOD <br />WATER HEATER <br />----`-- <br />IAUNDRYTRAV' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />I <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING — <br />EXHAUSTFAN <br />I <br />1 <br />SUB TOTAL f <br />—� <br />SUB TOTAL S <br />— PERMIT f <br />PERMIT S <br />ene iYrrlA.r <br />TOTAL FEE f <br />. <br />' <br />TOTAL FEE f <br />• VJI� VI�Lr: <br />FRONT SETBACK <br />BEAR SrTRACK <br />SIDE. SETBACK <br />PLAN CHECK NNOrn <br />FEE RECEIVE NO <br />USF ZONE <br />IOT AREA <br />VACANT SITE <br />FEES VALUATION FEE <br />-- <br />DYES O NO <br />NO OF DWELLING SIZE Of BLOGRI <br />RIIII DING <br />HEIGIO LIMITATION <br />UNITS <br />�T <br />OCCUPANT LOAD <br />• <br />BASEMENT <br />PLUMBING <br />GCnO^ANCY <br />NO M SIBRIS <br />MECHANICAL <br />_ <br />REASON <br />Y D <br />AODIIIONAI PI AN CIIFCK <br />FIRE SPRINKLER REO'0 <br />T <br />IT SON <br />OLDER <br />FIRE AIMMnEO'D <br />rinns novF Y9 <br />'uTF BOILING SIInClulnGE <br />rrrE or coNsr <br />�q <br />CITY OF EVERETT <br />LOCAL SALES <br />pi is, wonKs <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />