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AP�LICATIuN FOR CONSTRUC � ION PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •25y-B810 <br /> fl DEMOLITION fl COMBINATION �CI BUIIDING fl MECHANICAI �l PLUMBlNG fl SIGN <br /> PROJECT ADDRESS A R�S i p� <br /> AST <br /> x x xk L-: � E /o� ; �2� J� <br /> OWNEfl ' I MMl�00RE$5 G�TY 2�P PIIONE <br /> GA�NZ. N�Sv++ES Tti1G <br /> IEN�NT M�IlA0p1ES5 CITY 21P PMONE <br /> o � ��N ce,�,� ��.�.�� _— ��s- �s6� R a N <br /> ARCHITECT OR�ESIGNER M/JL AODRE55 Citt ZIP PIIONE <br /> �.aENL �lam�s �'�c `1004 `�'{ klu�'� Y1'INKi�7� 58d`7S 3`1)- GNY�f C4F�vzu�' a,taa� <br /> GENERnICONfMCTOR MRILPDDfiESS CIIY 21P P110NE $tATELILEN$EY <br /> MECNAlNC�I CONTP�CTOR M�II ADORE55 ��rv Zi� Pi�ONE STATE LICENSE� <br /> PLUMBWGCIXJTRACTOF M�IIADDRESS Cltt 21P PHONE STATEUCENSE� <br /> CONTMC�PR�CE OF W09�^��� <br /> �� HEATING SYSTEM: l GAS I�7 ELECTRIC rl_ . <br /> pESCqBE WOHN AH�$q1ARE FOpL1GE INVOLVED CONTACT VERSON AND PHONE NO. � <br /> l�lE'l.�) Cf'(R� )3Fu S�- <br /> �� ? I HEREBV CERTIFY THAT 1 HAVE READ AND EJ(AMINEO THIS <br /> J APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT.ALL <br /> wwvoseo usE or euaapr+c PROVISIONS OF LAWS AND OHDINANCES GOVERNING THIS TYPE OF <br /> S��\ WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�LDESCRIPTIONOFFROPEPTY(Sf10WNBELOW(3NARACNTWOCAPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �pi_��� pF AUTHORITY TO VIOLATE OR CANCEL THE PHOVISION OF ANV <br /> � OTHER STATE OR LOCAI LAW REGULATIN6 CONSTRUCTION OR THE <br /> � �p�����Q;f j. — PERFORMANCE OP CONSTRUCTION.THAT 1 AM AUTHORIZED BV THE <br /> OWNEfl OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCEL TA%ID.NUMBER CONTRACTORS LAW 1827 RCW AND 298200 WAC. <br /> GONSTRIICiION LON1 LENDEN.�ODIIESS.1ElEPMONE NUMBER X R/Y � �n��I� I 1 v <br /> � Sli � RE ' O�TE <br /> � CITY BUSINESS I.ICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TY7E OF FI%TURE OA ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) // � A/C--NHNDLGUNITS—H.P. ' <br /> BATHTUB 0 wg // ; FORCED AIR SYSTEMS—B.7.U. M E.A. ; <br /> LAVATORV(WASH BASIN) � i HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M <br /> KITCHEN SINK 6 DISP i CLOTHES ORYERS � <br /> DISHWASHER VENTILATION FAN ' <br /> UUNDflY TRAV ' RAMGE HOOD i <br /> CLOTHES WASHER WATFR HEATER <br /> URINAL � WOOD STOVE <br /> DRINKING FOUNTAIN i METAL FIREPIACE(WO00 BURNFNG) i <br /> FLOOR DRAW � � FIWEPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS i <br /> GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE <br /> _ � GAS PIPING <br /> � � E%HAUSTFAN � <br /> � ' <br /> i ' <br /> � <br /> � SUB TOTAL E � SUB TOTAL E <br /> PERMIT S i PERMIT S <br /> TOTALFEE E � TOTALFEE E <br /> FOR OFFICE USE ONLY: 5��'Y �' <br /> iRd1T SETB�CB / HE�R SETB/�CK � SIDE SETB�CK / PIAN CIIECK NUMBEP FEE � RECEIPT N0. <br /> � s' ��� ,-- 11,3/ <br /> usezor�� / i.or�aey O V�GRNiSITE FEES VIILUATION FEE <br /> � r i ves r i r+o euiioiHc j �2 ;� <br /> HEIGNT LtMIT�TI N NO.OF OWE0.1N6 SKE OF BlDOrI 1. <br /> � uHirs (j�jo S.F• 11v�N<s � pLUMBING �Q� <br /> $ B f .4P.OG�.�. <br /> OCCUV�NCY fqOfSIOPoES OCCUVRNiLO�D BASEMENT MECIIANICAL �O j�' � <br /> GRIXI _ - <br /> " v� Z fIYES NO ' <br /> FINE�IAP EO'[1 RF.�SON - AD(NIIONPI.PI.ANCIIf.CK 3 '�,�_ <br /> � OTMER <br /> FIRESPRINy1ERRE0'0 RF�S(N� -- ' <br /> %V O SLAIE BUIIOMG SURCIIPRGE �! 1 <br /> N � I <br /> TVFEOFCONSt PIr1NSAPPROVEDBY CITYOFEVERETT ruencwonKs � <br /> �.�,) i <br /> JM LOCALSALES ---- <br /> oare Z u TAX CODE IS 3105 TOTAL _ <br />