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APPLICATIO.� FOR CONSTRUCT.JN PERMIT <br /> CITY OF EVERETT• BUI�DING DIVISION <br /> 3'.!00 CEDAR STREET• EVERETT, WA 98201 • 259•8810 T <br /> �l DEMOUTION ( l COMBINATION I I BUILDING �MECHANICAL �� PLUMBING f l SIGN <br /> PROJECT ADDRESS <br /> / Sc �f/h�/ u-, . <br /> OWN[R MPILADDRESS CITY ZiP iONE <br /> �RY ��/JsAi✓ /�r� �✓E�zeTrr �t�L 1J�-v �'�2�' 3�7—�i69GG <br /> TENANT MAILADOfiE55 / /D� ��-D/CIT� � ,)f�� �� � �110NE��v_ <br /> Y� �� � <br /> 3 /(y 6 <br /> FFCHRF.CTORDESIGNE(i MAILADDRESS QTY ZIP PHONE <br /> GENERALCONTRFCTOB MAILADD�ESS CI*v :IP PnONE STF7ELICENSEx <br /> MEC MJICALCONTRACT R MAILA�DPE55 CIIY ZIP PIIONE STATEIICENSE� <br /> f�f� �.s�b .SNs/&�ats 7s�o4- l.��f��✓L 2'I�il 'Y<LLE �'L�O ?�✓�0922 [�l�tH5o77�J� <br /> PLUMBING CONTRAC OR MAIL ODRE55 GITV ZIP PHO4E STATE LICENSE• <br /> CONTRACT PPICE OF WORK <br /> '3 S • a HEATiNG SYSTEM: GAS Cl ELECTRIC Cl <br /> RIBE WORK ANO SOUARE POOTAGE INVOIVE � CONTACT PERSOY AND PHONE N0. <br /> 2 <br /> . � <br /> 81'�C. -LJV <br /> i <br /> _ J� . �+�/ C� w � _ O �� I HEREBY CERTIFY THAT I HAVE READ AND EkAMINED THIS <br /> .141dl�LI_ �'L��fjYl'CA-• APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROhO5EUU5E OF i�oydf�-7�-- � PROVISIONS OF LAWS AND ORDIiVANCE3 GOVERNING THIS TYPE OF <br /> v <br /> WORK WILL BE COMPLIED N.�ITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCflIPTIONOFPROPERTY(SHOWNBELOYlOFAifACNTYIOCOPI[S� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior BLOCN or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION GR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF S PROPER TO PERFORM TH`c WORK fOR WHICH <br /> APPLICATI IS A AND I COMPLY WITH THE STATE <br /> rARCELTnx I.D.NUMBER CONTR RS 1 . RCW AN Z9620O WAC. <br /> CONSTRUGTION LOPN LENOER.AODRE55.TEIEPMONE NOM9ER x � [,[, _ <br /> 51G ATUPE DAT <br /> CITY DUSINESS UCENSE NO. <br /> PLUMBING MECHANfCAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF FIXTURE OR ITEh1 FEE <br /> WATERCLOSET(TOILET) � AIC—A/HNDLGUNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRY TRAY � RANGE HOOD � <br /> CLOTHES WASHER WATER HEATER � <br /> URINAL ; WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GASFIREPLACE � <br /> SINK(SERVICE—BAR, ETC.) � GAS RANGE ' <br /> � � GAS PIPING i <br /> � EXHAUSTFAN � <br /> � ' <br /> i ' <br /> � T <br /> 1 � <br /> SUB TOTl1L S � SUB TOTAL S i — <br /> PERMIT S i PERMIT 5 /S � -- <br /> TOTALFEE S ' TOTALFEE S ��7 ' � <br /> FOR OFFICE USE ONLY: <br /> FRONTSET[fAGH RE/.RSETO�CN SIOESETOFCK PLANCHECK UM[3ER �GE RECEIPTNO. <br /> �Q� <br /> usezoNe ioranen vnenNrsiTE FEES VALUATION FEE <br /> � <br /> nvEs n rvo ow�owc ; <br /> HEIGHTLIMITPTION NO.OFUWLWNG SIZEOFBLDGRI. � <br /> i <br /> UNITS PWMOING � <br /> OCCUPANGY tlO.Oi5i0RIES OCCUPANTLOAp BASEMENT MECM�NICAL � <br /> GROUP — <br /> fl\'ES fl NO <br /> FlREALARMREO'0 R[ASON A�OITIONALPLANCNECK i <br /> i <br /> OTIILR i <br /> FIRE SPPINKLER REOD FEASON ' <br /> STATE 9UIl01NG SURCH�RGE � <br /> TVPEOFGONST. PLr1N5pPPqOVEDBY CITYOFEVERETT �UBLIC140PK5 � <br /> LOCAL.SALES — <br /> I <br /> oATE TAX CODE IS 3i05 TOTAL ; <br />