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APPLICAT14�1 FOR CONSTRUC? �ON PERMIT <br /> CITY OF FVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> fl DEMOUTION fl COMBINATION I�BUILDING f� MECHANICAL rl PLUMBING fl SIGN <br /> P ECT DDR 1 • <br /> �M/i�h )2'c30"L ��J �'�T <br /> ER IL�OORESS <br /> Cltt ZIP PNONE <br /> ,.a,L Sc,..r..�.�� 'L�3� F�-�.�. � E,.�ce�e.cc ��al 2J`�2-fi��_ <br /> TEN�NT M�ILADpqE55 <br /> ��TY Z�� ONONE <br /> �RCMT CiORppS�GNER MI111.�ODRE55 ��Ty <br /> z�� PHONE <br /> A.l. 4�w.ara-.cZ �210+� C`tn,+.t V..►Y Mwt+L.tc..� 'ikL-4'°l44 <br /> GENER���ONTR��iOR MML�OORE55 ��t� <br /> �� �, z�� PIIONE STRTEIICENSE� <br /> �l <br /> MECHINIC�ICONTR�CiOR MMLADDRE55 R�'�LGSL�g1O$ <br /> tJ/A ��rv Zi� PuOYE STATELICENSE� <br /> f <br /> PLUMBINGCONTqACiIXi MMLAWPESS CITY <br /> N�A Z�P FHONE STIITE LICENSE� <br /> GONTRACT PRICE OF WORK <br /> ��X� HEATING SYSTEM: fl GAS fl ELECTRIC f-1 <br /> OESCRIBENURK�NDSOU�REFOOTAGEINVOWEO LONi� RSQN�NUPH ENU. <br /> �"'�' � 'lc� c� . �...L•,n.� <br /> Z- <br /> a � w+E-w r...c�o'S <br /> At� p�,£�k_ � I HEqEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> enoroseo vse oF e�n�wr+a . APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � �C� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> iEcko��cr�Pna+°F�or�R �SHOWNgE��WONATT�CHTWOCppiES� WORK WILL BE COMPLIED W�TH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �aT�•�•�BLOCN oF S�Tc AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> �`���� OTHER STATE OR LOCAL LAW RE6ULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCEL TAx I.D.NUMBEp CONTRACTOHS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRI1CTIpN LO�N LENDER•ppRE55.TELEPIiONE NUMBEq � I ��^ I <br /> X�t�-/ A 1 l l �'S- <br /> SIGNATURE D TE k <br /> CITV BUSINESS 110EN5E NO. <br /> PlUM91N0 MECHANICAL <br /> �. TYPE OF FlIfTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> _ WATERCLOSET(TOILET) � q/C—/VHNDLOUNITS—H.P. � <br /> �.BATHTUB ; FOHCED AIR SYSTEMS—B.T.U. M E.A. � <br /> ' LAVATORY�(WASH BAS W� ' <br /> � HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 6 DISP - i CLOTHES DRYERS ' <br /> DISHWASHER ' <br /> ' VENTILATION FAN i <br /> LAUNDRY TRAV ; � -�RANGE HOOD � <br /> CLOTHES WASHER ' <br /> � :WATER HEATER , <br /> URINAL / � � WOOD STOVE � <br /> DRINKING F UNTAIN ; METAL FIREPLACE(WOOD BURNIN6) � <br /> _ FLOOR 0 AIN � FIREPLACE INSEqT(WOOD BURNING) � <br /> BACKFCOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE , <br /> ' GAS PIPING � <br /> i E%HAUSTFAN � <br /> � � <br /> � � <br /> � <br /> ---T— <br /> SUB TOTAL S ; SUB TOTAL S � <br /> PERMIT $ � PERMIT f T— <br /> TOTALFEE $ � TOTALFEE S � <br /> FOR OFFICE USE ONLY: ' � " <br /> COLC£[Tf17 <br /> fRONT SETp11CK RE�R SF.iB�CK SIDE /� P�AN CIIECN NUMBER FEE O I RECEIPT NO. <br /> usezoNe �Oi�REA VrC�Ni51tE FEES VALUATON FEE <br /> G' f 1 YES f 1 NO BUILDINC C�I i ./U <br /> IIEIGIR�IMIf I NOOFDWELLING SIIEOFBIDGT �� �� <br /> UNIiS ' �O D <br /> PIUMPING � <br /> i <br /> OCGIIPANCY NO OfS�ORiES OCCUPANTLO�D B�SEMENT T— <br /> �'^0�j •�� MFC114NIC�L i <br /> 5 �V fIYES NO � <br /> FIRE�LARN REOl1 RF�SO4 �UDIIIONAI PIpN C��f.CN ?���O <br /> �U O1NER �)� <br /> FIRFSPRINqERREnD RFAF(NJ <br /> _ / i__ <br /> /�/� STAIEflI11LDING5U0C11Af16E � �-n <br /> � <br /> rvvFOFr,oNsr ainv� ayyfoev CITYOFEVERETT nuni.ir.wonns `� : _. <br /> �/_ I /1 ��'� LOCAISALES _l_ <br /> /T o�ra -�j� TAX CODE IS 3105 TOTAL �� T <br />