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APPLICATI�N FOR CONSTR�IC`. �ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•6810 <br /> ❑ DEMOUTION ❑ COMBINATION �7 DUILDING Cl MECHANICAL ❑ AI.UMBING SIGN <br /> PROJECTADDRESS ��g �v���� <br /> M�L�- w�9 `�, �'l/�2E7T' �_..64_ 9�a-a� <br /> OWNER MAILAODRE55 611Y ZIP PHONE � <br /> ?EY�2y DK'�.pSr7M _/l5'Fveieerrnawu �,,.�rv �Var7' 9Y2-�� 3`t7 -G,966 <br /> TENANT M�ILAODRCSS CI7V ZIP PHONE — <br /> FV�p"TT. b�2/ENra� irrZocF_2v //S� EI/.¢TT MJ4LL Wiqc� �'/i�77' 9S2C$' 35`7 G r` 6 6 <br /> ARCHRFCTOROESIGNER NAILqDpRESS CITY ZIP PHONE <br /> GENEHAI.CO:lTRACTOq MAILADORESS CI7Y ZIP PHONE STATE UCENSE x <br /> 6��°��/NEo,vc,o. � o- 8oX Sz� 9 ��v�v��..�aod w�q. 9�a�p6 776-S'83�' (3�p,�y,`�co 77cn^ <br /> MECHANICALCONTRACTOR MqiLA�DRE55 CITV ?IP Pf10NE STATELICENSEI <br /> PLUMBINGCONTqACTOR MAILRODRE55 Gltt ZIP pHONE STAtELICcNSEr <br /> CONTRACTPRICEOF�OfiK — <br /> �3� y90 � HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑_ <br /> DESWIBE WOPK AN�SOUP.RE FOOIAGE INVOLVED CONT CT PERSON A PHONE N0. <br /> Z�ir s fs.// ' ' 32 D �REC� �tl.'bN b-$83S <br /> �L�'U�'` �^�f`�T�� S I �%�f ON E k/ST1NG- <br /> L3�.IGK F'���p�rioN I HEREBY CERTIFY THAT I HAVE READ AND EXAM�NED THIS <br /> PROPOSED VSEOFBUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> C'��' t � d' G���" S d'OYQ, PROVISIONS OF LAW,�'i AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL�ESCRIP110NOFPqOPEiiTY�SNOWNBEIOWORA7TACNTWOCOPIES) WORK WILL BE COM?LIED WITH WHETHER SP'cCIF1ED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocK___oF_ AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> S E L pL�7'r OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> _ ��_!q-N : PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOR2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> - APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> raace�rwc i.o.ruuMeea —"--� "— CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> 3969- 000 - oo ! - or��� Z <br /> C^4'TRUCPON I OAN LENUER,ADURESS,TEIEfNCNr_NUMBER x �_��� ����„� 3 2� /S <br /> .�IMML <br /> --• . SIGNATURE OFTE <br /> O'L�/ 7$' (� <br /> CIN BUSINE55 LICENSE NO. <br /> PLUMBING MECHANICA�_ <br /> NO. TYPE��F FIXTUHE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM �EE <br /> _ WATER CLOSET(TOILET) � .4/G—A�NNDI�UNITS—H.P. I <br /> BATHTUB ; POp;,ED AiH C�(STEMS—B.T.U. M E.A. � <br /> � <br /> Lp'JATORY fWASH BASIN) � HEAT PUMP , <br /> _ SHOWER � UNIT hEATERS--B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES DF.YcRS � <br /> DISHWASHER � VENTILP,I�I"v!J FAN i <br /> LAUNDRY TRAY � <br /> , RANGEfi00D � <br /> CLOTHE: WASHER � WATER HEATER , <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) ; <br /> _ FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTEAS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE � <br /> � ; GAS PIPING � <br /> _. i EXHAUST FAN ; <br /> _ ' i <br /> � , <br /> � , <br /> � � i <br /> � SUB TOTAL S ; SUB TOTAL 5 � <br /> PERMIT S i PERMIT $ , <br /> TOTAL FEE $ � TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBOCK qEARSFT�ACK SIOESETAACH PIt.NCHECI CU'AOER FEE �� RECEIfly0�� <br /> ��l <br /> us=_zoNe �OTAREA vncnNrsire __ FEES VALUATION FEE <br /> ❑ves ❑ rvo —� <br /> ounniNc � � � <br /> NEIu'HTUMITATION NOOFOWELLING 512EOF�LDG/CL --- <br /> �i'.= ;OC-' <br /> UNITS i <br /> GLUI/i11NG i <br /> 7CCUPRtiCY NOAFSTORIES OCCUPFNTLOAD BAS[MENi --�� <br /> ����" i MECINAIChI i <br /> ❑VES ❑ NO <br /> i <br /> FIREALFRMREO'D REASON -- AODIilONA1.PIANCHECK i <br /> i <br /> . ..._ OTMEB ; <br /> FIR.9 3PRINKI=.A REQ D RE 1SON � � <br /> � <br /> ` SThTEBUIL�INGSURGHARGE � h�i <br /> TYPEOfCONST YI:� iAPP !EDBV CI7YOFEVERETT ru?��.�wonKs i <br /> „� IOCAL SALES --- � <br /> _ DA:E � ,1� 1'hX CODE IS 3705 TCTAL �� -. � <br />