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APPLICATION FOR �CONSTi�iUCT10N PERMIT <br />�"'JTY OF EVERETT • BUILDING DIVISIO�� <br />3200 �_OAR STREET • EVERETT, WA BB201 • 25g-BB10 <br />❑ DEMOUTION ❑ COMBINATION ❑ BUILDIN(i ❑ MECHANICAL ❑ PLUMBINO ❑ SION <br />PROJECTADDRESS: 351�o I�e,D��C.�q1.C. AV4, EU6k.�Tl- Wq �J�e201 <br />01MIEN MN1.110MIE55 pTY IIP %IpHE <br />t(,2�( po1TER'DRWL QqRTNF.RsH�P�� ��05 WcsrLqK'E A�t N• Si.d WA. 4'81oq (aoc)a8�-3770 <br />7E/uNf 4NL �ODAE55 GTY IIP p��q� <br />b[RTi E�iP• S'ZLuTpL �ao $oLLTH SPRuc�,. �yqL�NVTotJ , Wq (�3�0� �SS-9aao <br />/�RLNI[GTOROESIGNER WII E55 CI1Y IIP P11pNE <br />�1r'►SEy �Nf�+4TING S'11Quc�'URnL E►�6"• IgIQ WEST�.MKE q�E. N. SEW. (ao6�o2z33'�3S'] <br />GENEIW CONIRI�CTOR MIU4 �MME55 GITY 111` PifONE itATE IICENSE � <br />11E�GotJST. lu� • 403�. QeKo�en D.. Sw. T..c. 99Y99 58i- �563 NfiucoI t0'7y 1.3 <br />6�Ed1/�NiG1t CONTRIICTOR MMl �DdiE55 Qtt IiP PIIONE 5lATE LiCENSE � <br />NG i�l ln a�-9 �� <br />PIUMBINC CONTR�G10q M�II /�DORE55 GTY jIP PMONE STATE LICLNSE � <br />`30,000 <br />oescwe¢ �wroc �no sou�nE rcar�ae wvav¢o <br />;Nwe.wT' opLW�NGS FoR it� I,Z'xIH' IQn1.L•4p <br />jtJD �-3�'Ls MANDeoRS T CAUSTkqe.T q1� <br />EQu�p�evT W+sH PAO iN P�aK�ai lor p�vtw <br />rnoroseD use oF �nlprrc <br />�ctw�o»,cNrREN�a�, FAc.,urv <br />1E61LL OESCRIPiION QF P110PF:ttY ISlIOVR/lELOW OR �T7ACH lYM7 COPIES) <br />iot e�ocR oF <br />wneei r� i o. Mnneen <br />57l.0 008 000 08 oy-p <br />CONSTRUCTqN lOM! 1ENDER. �OORESS. tEIE%KKIE MAMER <br />PLUYBING � <br />NO. TYPE OF FlXTURE OR ITEM FEE <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKIN6 FOUNTA�N <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — 3AR. ETC.1 <br />FOR OFFICE USE ONLY: <br />FAONT SETB�CN {iEAP SETBACK <br />I^� �. • <br />USE 2�E � I IOT <br />) <br />HE1G11T UM jAT10N. <br />�S <br />N,I <br />PERMIT S � <br />70TAL FEE S � <br />SIUE STETBnCIt <br />V / <br />VAC�NT $IfE <br />❑YES NG <br />NO OF DWELLIy(3 <br />UNIfS / <br />/ • � <br />SIZE Of BIDGRI <br />❑YES ❑ NO <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />GONTACT PERSON AHD PIIIXIE fp <br />RW�,PN R�c-NNEY2 <br />,' 30�0"►. <br />1 HEREBY CERTIFY THAT I H'rNE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAAnE TO BE TRU'_ AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GO�: cRNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO YIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATIN6 CANSTRUCT�ON OR TNE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTFIORIIED BY THE <br />OWNER OF THIS PROPEeitY TO PERFOpM TME WORK FOFi WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />Y/���x.� �.ti� 3- I Y- 4� <br />ATURE D�iE <br />CITY &151NE55 LICENSE NO <br />MECHANICAI <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORVERS <br />WUOD STOVE <br />FIREPLACEINSERT <br />PIPING <br />PI�H C11EGN NUMIIER <br />e�ni owr, <br />PIIIIAOING <br />MECII�NIC�I <br />�DDIIION�I PI�NC��fLN <br />Oi11Ef1 <br />SI�IE BIIIIDIHG SURCIIM6E <br />oFr.ur+s� rinHsnrrnwennr CITYOFEVEREIT �runnr.vrnnns <br />.. / n;� LOCAL SALES <br />v—.v ,,.,� �_, o c i TAX CODE IS 3105 I TOTAI <br />FEE <br />SUB TOTAL f � <br />PERMIT f �—T— <br />TOTALfEE S ' <br />GEf REf.EiPT ND <br />VAIUATION FEE <br />30 000 '' ��j <br />i <br />{ <br />i <br />1 <br />i <br />� yl '. <br />_ �� � - �_ <br />i <br />� �. <br />! / i J <br />