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,-- <br /> APPLICATItiN F'�if; C01�iSTRUCTION PERMIT <br /> CITY OF EVER�ETT•BUILGNNG RIUISION � <br /> 3200 CEDAR STREET• EVERETT, WA 99201 •259-8810 <br /> I I OEMOLITION I I COMBINATION I� BUILDING I I MECHANICAL I I PLUMBING I I SIGN <br /> PROJECT ADDRESS <br /> i � �/ac�z S� <br /> OWNER MRIIROORESS CIiV )IP PIIONE <br /> IENAN! MAIIAUOqF[5 CIIV �-- ZIP PHONE <br /> RRCHIlEG�ORDESiGNER MRIL�OUREbS CIIY ZIP pHpryE �— <br /> GENERALCONIReCiOR M41LROppESS t.11v )m PHONE STqTEUCENSE/ <br /> L�L, ��ENT!/2,�-S ��'�B/8 <br /> / 7i/ S✓cPG,�cGN tua✓ 6ycp,er7- i.J,/9PZ0�! -�ic 9ie� LLVEN/it O`VOS <br /> MECNANICAL CONTRACTOR MAR qD�RE55 / , 61tY ZIP PIIONE STATE LICENSE• <br /> (�� <br /> i`IUMBINGCONTRACTOR MMLADOP-45 r,��y ZIP PHONE STAtELICENSE� <br /> CONfMCTPRICEOF RN � —� <br /> 3 C�� HEATING SYSTEM: jX(GAS ❑ELECTRIC 1-1 <br /> OESCRIBE WORK�ND SOUaRE FOOTnGE INVOlVEO CONTACT PERSON pNG PHONE NO. <br /> .�fai �. zz �r- �i22r' �vi,rD zyo-�s�s <br /> G�tYs� 365sq�-r 5�co.v� x2. 7Z8 s Fr Lo�z.vC us..�C /o-9/oa <br /> �p��L ��C,j�5,� �7- I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> vqpPoSEO JSE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � ��L �s PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED IIEHEIN OR <br /> LEGAlDESCRIPt10NOFPROPERTY(SHOWNBELOWORATTpCHTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> iot�aiocK ov� 5/IJ AUTHORITV TU VIOLATE OR CANCEI THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ___ PERFORC�ANCE OF CONSTRUCTION.THAT I AM AUTHOHIZED BY THE <br /> OWNER OF THIS PROf'ERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> VA9CEl iN(I D N ER� CONTRA�W 18.27 RCW AND 296200 WAC. <br /> �3�, i� / <br /> COn�a�!O�Lh.W�pLEN6ER.A ORESS,TELEPHONE NUMBER X �� �� �� ��. /�� <br /> ___�.�7A�K SIGNATURE D TE� <br /> CITV BUSMESS LICENSE NO. <br /> P�V���' MECHANICAL � <br /> NO. TVVE OF FIXTURE OR ITEM FEE NO. TYPE CF FIXTURE OR ITEM FEE <br /> WATER C�OSET(70iLET) � -�-- q/C—NFiNDLCa UNITS—H.P. � <br /> Z BATNTUB � FORCED AIR SVSTEMS—B.T.U. M E.A. ' <br /> i <br /> ,3 LAVATORV(WASH BASIN) -�� HEAT PUMP <br /> SFiOWER -e- UNITHEATERS—B.T.U. M <br /> • � ( KITOHEN SINK 8 DISP CLOTHES DRVERS � <br /> / DISHWASHER VENTILATION FAN <br /> $- IAUNDRY TqAV ' � RANGE HOOD � <br /> / CLOTHES WASHER WATER HEATER � <br /> -B- URINAL {j' WOOD STOVE <br /> {�' DRINKING FOUNTAIN i METAI FIREPLACE ' � <br /> � <br /> FLOOR ORAIN -�- FIREPLACE INSERT(WOOD BURNING) <br /> BACKFLOWPfaEVENTEfiS / GASFIREPLACE (MCTF7L i <br /> -�- SINK(SERVICE—BAR,ETC.) -�- GAS RANGE <br /> � GAS PIPING <br /> EXHAUSTFAN J— <br /> i <br /> i <br /> — i <br /> SUB TOTAL $ � SUB TOTAL $ ' <br /> PERMIT $ PERMIT $ � <br /> TOTALFEE $ TOTALFEE $ � <br /> FOR OFFICE USE ONl_Y: <br /> FRONT SETBqCN � PEAR Sijp17GN� SIDE SETBrjCK PI.AN CIIECK NVM9ER FEE ` RECEIPT NO. <br /> / <br /> �r. �=� 5 �i�� �i�/� <br /> usezor+e tornnen �J VACTNiSITE FEES VALUATION FEE <br /> /e.-" j 7��� fIYES I1NO BUILDiNG <br /> �/ ZZ �I <br /> IKIGNT UMIT�TION_ .-. NO.OF OWEL'JNG SIZE OF BWG/jL 1 <br /> �/ C/1 UNIiS /SSU J'.r. L�iHV f <br /> L/C/ 3vJ S,f. (aR.tAGE rwnneiHc '7 <br /> OCCUCANCY ND OFSTqpES OCCUPnNiLORO B�SEMEN! q � <br /> GlIWV �f � MECHANICAL <br /> �,.} U-1 {.� f1YE5 fY�FO - � � <br /> FlAE AIAqM f1E0'D REASON �ODI�IONqL PLAN CNEGK "� !Q/7 <br /> fJ L <br /> OTNER i <br /> GIRESPPiNNLER3E0'0 RE�SON <br /> 1 <br /> STAtE BUIIDING SURCHM(iE � �/�r <br /> �/ <br /> iVCEOFCON3t vLANSAPFROVEDBV CITYOFEVERETT PUBUCWORKS �D' <br /> -�y- LOCALSALES <br /> JL `� �onre � Z 96 TAX CODE IS 3105 TOTAL �'� '-7;7Z <br />