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APl�LICATIOr,� FOR CONSTRUCT►.!N PE�tMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 9B2U1 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING � MECHANICAL O PLUMBING ❑ SIGN <br /> PROJECTADDRESS:_pj�) �V��n� 1�/tY <br /> ��EE/tc�QSI uP O��li:?X 3�k033 ��1-'1'�L� qg� 2� m�N $ — �O y� <br /> E I � ���Stb �1L510�.12[��1-�f.� Wf�i' �V�]2�"�T <br /> 7EN�NT MeIl��011E55 CIIY IIP PhONE <br /> ARCIIIT[�TOil0E5�GHEf1 M�IIADCfiE55 GIIY 71P PIIONF. <br /> GENEMtCONIRACTp' MIJLADDeE55 CIIY llP PIIONE $UiEIIC[NSEr <br /> �M��uNi��m�c�r10 �u�ooaEssllhl2 N•42(3�°-1�YW`F �•�10�Z' �9D�— �$bll 6b2-(oSf ELICENSiE I�AU3aVP� <br /> PyLUMBINGCON1R�CiOR N�ILAODRE55 CIfY IIP PIIOHE SiAIEIICENSE• <br /> H �2 Buo <br /> LONTRAGT PRICE OF Y/pRK <br /> ,y�-�,� � - � HEATING SYSTEM: ❑GAS ❑ ELECTRIC � � <br /> OESCW BE MORN ANO SOUARE FOOTAGE INVpLVED CONT�CT PCRSON AND CIIONE NO <br /> 6 n1 E =bN ' o+J <br /> NG�,J onl � rL. �('l� l.�E��INS 68 � - <br /> L� �, I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> rnpoa�oSE.�D�Se oF B�itar+a APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> h�+ PSt�� D P�f GG PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPE OF <br /> � WORK WILL BE COMPL:ED WITH WHETHER SPECIFIED HEREIN OR <br /> IEWLDESCRIPTIONOFPROPERN�SNOWNBEIOWORATfALN7WOCO�IES) NOT. THE GRANTINC OF A PFRMIT DOES NOT PRESUME TO GIVE <br /> ioT e�ocK oF AUTHORITY TO VIOLATE Oti CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW PEGULATING CONSTRUCTION OR THE <br /> I�C�I-}e� S' PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF TH�S PROf'ERTY TO PERFORM THE WORK FOR WHICH <br /> APPIICATION IS MADE AND I COMPLY WITH TNE STATE <br /> PARLELTN(I.O.NUMBEA CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRVCTION LON1 LENDER,�UURESS.TELEMIOHE M/MBEq x �µ..Q}� (r� � �( �CV � � <br /> SK,NAtUiiE DI1TE <br /> cm eus�r,ess i�cens[r+o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FE NO. TYPE OP EOUIPMENT �EE <br /> WATER CLOSEi(TOILE� � A/C—AMNDLG UNfTS ' <br /> BATHTUB ; FORCED AIR SYSTEMS ; <br /> LAVATORY(WASH BASIN) i HEAT PUMP � <br /> SHOWER ' UNITHEATERS ' <br /> KITCHEN SINK 8 DISP � CLOTHES�RVERS � <br /> DISHWASHER � HANGE HOOD � <br /> LAUNORY TRAV ; WATER HEATER ; <br /> CLOTHES WASHER � WOODSTOVE <br /> URINAL ' METAI FIREPLACE(WOOD BURNIIJG) ' <br /> UAINKING FOUNTAI ; FIREPLACE INSERi(WOOD BURNING) � <br /> FLG7R ORAM � GAS FIREPLACE ' <br /> BACKFLOW P VENTERS ; GASRANGE � <br /> SINK(SERV E—BAR,ETC.) Gl1S PIPING � <br /> � IXHAUST FAN <br /> i ' <br /> � � <br /> � � <br /> � , <br /> SUB TOTAL S ; SUB 1 OTAL S ; <br /> PERMIT S � PERMIT f � <br /> TOTAL FEE S ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> fROHTSETBACK PEAf15ETBACN S�DESEIBA�N PUIiGnGCK Cf1� fEF �FCfV'iN0 <br /> ����5 <br /> uSEtone ior�nE� wtu+rsite FEES VALUATION FEE <br /> ❑YES ❑ NO DUIIDINf. � <br /> HEIGNT LIMITATION NO OF DWEILIHG 512E OF BLOG/f I � <br /> UHIfS PlUY01NG � <br /> OCCUPANCY Iq OfStpPoFS OGCUPANTl0�0 BASEMENT MECII�NiCAL a�/ I <br /> GfiWP <br /> ❑YES O HO <br /> FIRESPRIHKLERAEO'D �FASQY �OD�IIONeI�UNCrIf.Gk _ <br /> on�en <br /> FIRE�LMMREO'0 AEAcpN � <br /> STAIE 9Wl0iNG SURCII�fIGE <br /> _, i— <br /> trreoar,or+sr vinvs�nrnovEoor CITYOFEVERETT rumir,wonKs ' <br /> LOCAL SALES — —'-�— <br /> o�rE TAX CODE IS 3105 7o7A1 <br />