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APPLICATICA FOR CONSTRUCT''N PERMIT <br />ITY OF STREET <br />• RETT, A DIVISION <br />�J 3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION COMBINATION BUILDING MECHANICAL ��PLUMBING ❑ SIGN <br />PROJECT ADDRES �s 9 �''� S� �� <br />OWNER MAIL AODRE SS -- <br />IwCITY ),II, _ - r`i IoIlf <br />CITY ADCIUTECI On DESIGNER MAIL ADDRESS ON )II` PNONF <br />GFNFF4L CONTRACTOO MAIL AODRI SS CITY )Ir I•IIONF $IAIE IICE NSE• <br />C��-'i-Atf� <br />MFIFNANICAL CONInACTOn MAIL ADDRFSS CITY )Ir PHONE 547E UCf NSE F <br />MAII <br />Dv <br />71P PHONE STATE LICENSE • <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: GAS ❑ ELECTRIC ElDE <br />SCRIBE WORK AN050UAR�E- y/F�OOTAiE INVIXVEO <br />e <br />C c �-%• �yV <br />CONTACT PFn50NANO rmp"• Io �y�.^j1 �- <br />I HEREBY CERTIFY iIIAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND E L ;1v 'HE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS ANU JRDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTH \STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PE OR A CEO OF C ST CT N. THAT I AM AUTHORIZED BY THE <br />OW ER I PR E TO ERFORM THE RK FOR WHICH <br />AP ICATI I M I COMPLY W TH THE STATE <br />CO F W 7 / AND 296. 00..TTWAC / <br />X //I (✓�/f <br />PnorosEoyse OP�In.owa <br />1�. �"� <br />' <br />— <br />LEGAL oEscnIPRON OF PROPELITY (SIIOWPI BELOw ORATTAcU Two COPIES) <br />LOT �(Q_. BLOCK Or <br />�n�I '�,' I , /I >� -' �C��� . <br />V /J L) Y 1 L V' ✓ <br />PARCEL TAXI o MDAIBER <br />CONSTnUCTIONLOANLENUEn. ADDRESS. TELEPBONENUMnEn <br />51GNA IRE p [ <br />CITY BUSINESS LICENSE NO <br />PLUMBING _ <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />--� <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C —WC UNITS <br />�— <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />' <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />�— <br />SHOWER <br />_ <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />-1 <br />RANGE HOOD <br />—�— <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />1 <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />' <br />SINK (SERVICE — BAR, ETC.) <br />_ <br />v <br />GAS PIPING <br />EXHAUST FAN <br />—�— <br />i <br />' Z <br />I <br />I <br />� <br />I <br />- <br />SUB TOTAL f <br />SUB TOTAL f <br />_ PERMIT fT <br />—� _ <br />PERMIT S <br />TOTAL FEE f <br />TOTAL FEE S <br />i— <br />FOR OFFICE USE ONLY: <br />FEIONTSETIAC <br />PEARSFTBA` I <br />SIDE Sf iBACM <br />^IANCIIECKNUMBFn <br />J <br />FEE <br />nFCFwT NO <br />USE ZDNB ,, <br />/LS-' <br />LOT AFEA <br />VACANT SITE <br />❑YES O No <br />FEES <br />VALUArION <br />FEE <br />Inn DING <br />_ <br />IIEIGNT LIMITATION / <br />7 <br />NOIIOF DWELLING <br />SIIZEE OF ELMOI <br />Ib<lry / �. F. <br />PLUMBING <br />MFCIIANIf.AI <br />��a— <br />I <br />OCCUPANCY <br />0 U <br />�.a J <br />NO M SRAIES <br />OCCUPANT LOAD <br />B SEMENT <br />// <br />❑YFS U4�0 <br />— <br />ADM I IONAI PL AN CI IT CK <br />--.--- <br />- <br />1 <br />FIR SPRINKLEN REDO <br />FIFABON <br />OIIIER <br />I <br />FIRE ALARM RED <br />nE ASON <br />STAIF EDM DING SNRCIIARGI <br />I— <br />TYPE or OWIST <br />.jL' /J <br />PLANSAPPEIv BY <br />DATE I I <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />runncwom,; <br />— <br />-- -1— <br />TOTAL <br />1 <br />