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APPLICATIGrI FOR COIVSTRUCTION PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> I�l DEMOLITION fl COMBINATION fl BUILDING fl MECHANICAL 1 PLUMBING fl SIGN <br /> PROJECT ADDRES$ <br /> ��I7 9 <br /> OWNER MAILADUAE55 �ITY $IP PHONE I <br /> ��L�'r�Pt,4K �9�4;(RY�V FU�2ET)- �1�01 <br /> TENANT�/ n� /y�r�!AC Pf.S �/1� l CITY J IIP 7 /P�N(O�y E /� ,/ '/ <br /> a''C'1��� / l�A������<7'�1-( � /��-�l�i7/ 7.�J ���UJ Ln�7�-"' _i`� <br /> ARCHIiECTOR0E51GNER ILAODRE55 CITY 21P ° PIIONE <br /> GENERRL CONTpaC10R Mnll ADOf1E5S ptV�r'i]L^lt—ZIP P110N@ SiATL LICENSE� <br /> �►FiN -T-wrr�e�.• iCla.l��7(,c1`(sreiea G`.`" 9S�- 2�� 3��(y�s� b�'Dt�zc7i�8 <br /> MECNANICAICONTRACTOR MAIIA��RE55 CITY ZIP PIIONE STATEUCENSE� <br /> PLUMBINGCONTR�CTOR MaIIADDFE55 Gltt ZIP PHONE SUTEUCENSE� <br /> CONT TPPIC�.OFWORK <br /> L_Lj HEATING SYSTEM: Cl GAS 1-1 ELECTRIC fl <br /> DESCRIBE WORK ANO SOURFE FOOTAGE INVOlVEO CON7FCY VERSON AND PNONE NO. <br /> — i t�c7 w�i �v t4T <br /> � n�st-ALL 3=D irv�rYtS,�J e <br /> � �C�.,379p�J- .�� IO.3R�y 5� F�R� I HEREBY CERTIFY THAT I HAYE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBVIlDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC7.ALL <br /> ;-y�,�' � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ICoI WORK WILL BE COMPLIED WITH WHETHER 3pECIFIED HEREIN OR <br /> � LECAL�O'E�SC('RIP�TIO�NOFPROPERT�Y��QSHO�WNBELOWORARACNTWOCOPiES) NOT. THE GRANTING OF A PERMIT �DES NOT PRESUME TO GIVE <br /> . �or�1_BIOCN."'!11 oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> � � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFUHMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV 7HE <br /> OWNER OF THIS PROFERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTA%LD.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRVC110N LO�N LENDER,IIDDRESS.TEIEPHONE NUMBER X �� �� /� � '/ —,�`p <br /> SI� � �. FQ <br /> ty1RE � DATE <br /> CITY OUSINE55 UCENSE NO. <br /> PLUMBINQ MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. � <br /> BATHTUB ; FOFCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP �— <br /> -•-- <br /> SHOWER � UNITHEATERS—�.T.U. M ; <br /> KI?CHEN SINK 8 DISP ; CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> IAUNDRYTRAV ; RANGEHOOD ' <br /> � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL � WOOD STOVE ' <br /> DFINKING FOUNTAIN i MEIAL FiflEPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOnD BURNING) � <br /> BACKFLOW PREVENTERS � G4S FIREPLACE � <br /> SINK(SERVICE—BAR. ETC.) � GAS RANGE � <br /> GAS PIPING ' <br /> i EXHAUSTFAN i <br /> i � <br /> � i <br /> � � <br /> � � <br /> SUB TOTAL $ � SUB TOTAL $ ; <br /> PERMIT S � PERMIT S i <br /> TOTALFEE $ � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> LRONTSETORGK REMSFTBACK SIUESETO�CK PLANCIIECNNUMOER fEE ��� RECEIPTNO <br /> rJ�/t � N�q 7,` . <br /> USEZON� LpTAREA � VACANiSITE FEES V LUATION FEE <br /> � � .`�' f1VE5 �NO BUILOING � <br /> _ � <br /> IIEIGNT LIMITATION NO Of OWElUNO S12E OF BL�GR.I <br /> � ` UNIfS PWk01NG + <br /> GROUP^NCV NO 0�SIOFiES OGCUPANT LOR� BASEIAENT MFCIUNICnL � � <br /> IlYES fl Np — i <br /> FIREAURMREOD IiFR50Y ADDITIDNAI.PL�NCNECK i <br /> � <br /> 0T11EH � <br /> � <br /> FIRESPRINKLERPEO❑ REA�ON � <br /> i <br /> STNE[IUILUINO SURLIIMGE i <br /> TYPEOFf,ONST P�ANSAPf'POVEDOV CITYOFEVERETT ruour.wonKs ' <br /> �M LOCALSALES �— <br /> DATE °� (r TAX CODE IS 3105 TOTAL 1 <br />