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APPLICATI,*.. N FOR CONSTRUCT iON PERMIT <br />C'TY OF ERETT • DIVISION <br />3?OU CEDA19 STREET • EVERETT, RETT, WA <br />88201 • 2!H9-8810 <br />❑ DEMOL(TION COMBINATION ❑ BUILDING ❑ MECHA141CAL 13 PLUMBING Cl SIGN <br />PROJECTADDRESS: G c�3e9 �'T 5 Cni <br />ACNTECT OA MSKSNEII MAIL ADDRESS CITY4 <br />) OENFML CONTTNACCTOR UMLAODF1ESS LIIY <br />J tcmAA/tMAIL AGRESS r�CITY <br />N UMBNG <br />MAIL <br />-LZy`� gT1AF <br />lj»-", I Zee <br />ZIP <br />HEATING SYSTEM: <br />CONTACT PERSON AND PHONE <br />ONE <br />PIHONE STATE V'ENSE E <br />C 341- - 17-3ci s I:rO <br />PHONE STATE LICENSE I <br />GAS ❑ ELECTRIC ❑ <br />I 1 HEREBY CERTIF THAT I HAVE READ AND EXAMINED THIS <br />vROPOYo USE OF BUILCOW 1 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />-1 r-L� <br />LOT BLOCK OF ml -,; I k <br />NUI. It URANTING OF A PERL4T DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOF.MANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY TI IE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />ONTRACI Off$ LAW 18,27 RCW AND 296.200 WAC. <br />•t"ylAlTy1113dd \\�-� JIS1Q� <br />_ <br />PAFK;EL TA. I D NUMBER <br />FANS11K1CTTON IOAH TENDER. ADdTE58. IF1EP110NE NVUBERFIE <br />_ <br />'DATE <br />CITY BUSINESS LICE SEND <br />PLUMBING <br />MECHANICAL <br />Mn. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) _ <br />H <br />, /V—A/HNDLG UNITS <br />Z <br />BATHTUB <br />_ <br />FORCED AIFI SYSTEMS <br />LAVATORY (WASH BASIN) <br />H <br />HEAT PUMP <br />_ <br />SHOIVER <br />I <br />; <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />CLOTHES DRVEgB- <br />DISHWASHEq <br />1 <br />RANGE HOUD <br />; <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />) <br />1 <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />1 <br />URINAL <br />DRINKING FOIYITAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR 51RAIN <br />GAS FIREPLACE <br />BACY.FLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />OAS PIPING <br />At I <br />EXHAUSTFAN <br />i <br />1 <br />T <br />I <br />I <br />SUB TOTAL $ <br />I <br />SUB TOTAL S <br />PERMIT f <br />_ <br />PERMIT $ <br />TOTAL FEE S <br />TOTAL FEE S <br />PUN UI-FIL:E USE ONLY: <br />FFIONT SFTBACN <br />REM SE/BACX <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEF <br />RECEIPT NO <br />II SE IOFHE <br />LOTMEA <br />VACMT SITE <br />FEES <br />VALUATION <br />FEE <br />_ <br />DYES ❑ NO <br />BUILDING <br />IG' �., <br />I <br />I <br />NEgNI 1114 TATN]N <br />NO aDWELLINO <br />UNITS <br />312E OF BlOG 11 <br />t <br />S.If <br />PLUMBING <br />1, .7 <br />OCCUPANCY <br />CUPANCY <br />MU N 51(WIS <br />OCCUPANTLOAO <br />BASEMENT <br />2 <br />/ <br />MFCNM1Gt <br />l <br />-/ <br />DYES a'NO <br />ADDITIONAL Pt M CIHFCK <br />HIIE DPRINKLER REO'O <br />REASON <br />OTHER <br />fIRENMMREO'D <br />_ <br />RF ASON <br />STATE BUILDING SURCHAnOF <br />I IPE OF r•ONSr <br />PLANSMPNOVEO BY <br />CITY OF EVERETT P081 IC YroRKs <br />r <br />LOCAL SALES <br />—.L_- <br />-/4 <br />DAIL// 7 I <br />TAX CODE IS 3105 TOTAL <br />i <br />