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APPLICATI4N FOR CONSTRUCT �ON PERMIT� <br /> CITY OF EVEFETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259•BR70 <br /> fl DEMOUTION f 1 COMBINATION I�Q BUILDING I I MECHANICAL i 1 PLUMBING f l SIGN <br /> PROJECT ADDRESS R 5 i 0 s ST /� l <br /> _ L or �. x X x x S'n sr £ucae ff /�v ���.�t_ J� <br /> OWNER MIJl�00HE55 CITV 2iP PNONE <br /> �ENL t1w,.tr3 ��C <br /> I TEINNT MML40ORE55 f.RV ZIF PHONE <br /> D�`t �lil H) � L //l�t'".�S <br /> RCHAECTORDES EP MAIL�DORE55 Cltt ZIP PHONE <br /> . �Nz �omES Z'Nc 900�! yy cu� �, 11��e�,TF.n wA 98a?s ap.�,�t��`y�a G,a�Nzyr <br /> I GENFRAI CONTPAC�OR M41UpDRE55 Cirv piP PHONE STATE LI NSE� osa o3 <br />�I <br /> NECHANICAL CONTRACTOR M�II RDOPE55 pTV 21P PNONE STnTE LICENSE X <br /> PLUMBMIGCONTpACTOR M�IlA00RE55 CIiV ilP PHONE STATEUCENSE� <br /> CONlMf:T VPICE OF WIX1N <br /> HEATING SYSTEM: GAS n ELECTqIC rl <br /> DESCMBE V/ORI(�NU SWARE FOOTIIGE INVOIVED NT�Q GERSONRNO PNONE NO <br /> ;a wsN Jo <br /> I HEREBV CERTIFV THAT I HAVE READ AND EXAh;INED THIS <br /> Pn000SEo u5E or�l�wflC APP�ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT AlL <br /> ,�K PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREiN OR <br /> . LEGAlOESCPoVTIONOFPROPERTVISHOWNBELOWORATTACHTWOCOVIESI NOT. THE GRANTING OP A PERMIT DOES NOT PRESUME TO GIVE <br /> ioT e�ocK oF AUTHORITV TO VIOLATE OR C.4NCEL THE PROVISIOk OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOHIZED BV THE <br /> OWNER OF T�iIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THF STATE <br /> WIIICEI TAJI t0.NUMBER CONTRACTORS LAW iB27 RCW AND 296.200 WAC. <br /> CONSTAlILT10N LO�N LENDER.AWRESS.TEIEPHONE NUMBER x •y�,�,� �yy�/Q • n)y �/I l C(� <br /> SIGNATURE OAtE <br /> � CITY BUSMESS LICENSE NO. <br /> iLUN&NG MECHANICAL <br /> � NO. TYPE OF FlMURE OR REM FEE NO. 7VPE OF�EGUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNRS—H.P. <br /> BATHTUB S �W FORCEDAIRSVSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) HEAT PUMP <br /> SHOWER � UNIT HEATEFS—B.T.U. M <br /> KRCHEN SINK d DISP CLOTHES DRYERS <br /> DISHWASHER VENTILATION FAN � <br /> LAUNDRY TRAV RANGE HOOD <br /> � CLOTHES WASHER WATER HEATER <br /> URINAL WOOD STOVE ' <br /> DRINKING FOUNTAIN METAL FIREPLACE(WO00 BUHNING) <br /> FLOOR DRAIN � FIREPLACE INSERY(WOOD BURNING) � <br /> BACKFLOW PREVENTERS � GASFIREPLACE_ ,_ <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE _ <br /> GAS PIPING <br /> ? EXHAUST F/NV � <br /> —� <br /> � SUBTOTAL S � SUBTOTAL $ <br /> PERMIT $ i PERMIT $ <br /> TOTALFEE 5 � TOTALFEE $ <br /> FOH OFFICE USE ONLY: <br /> FROH�SE��� REAR S TF B�CN � BA� / FIAN CHECN NUMBFR FEE� � RECEIPT NO. <br /> l�� L75 <br /> GC/ <br /> usE zor�_ �/ im naen VRCRNi SITE FEES VALUATION FEE <br /> � i i res r; No euuni�vc 7 6 ;�� <br /> HEIGHT LIM17A7Jf]p� � UN TOF DWELIING 512E F L I <br /> �v ' .F. L l V/Aki + PLUMBING ,3 ;� <br /> ARA�aE <br /> OCCUi�NGV NO OF S��AIES OCCUFRNT LOA� B�SEMENT � � MEf.HANICAI Gj D i(�[� <br /> GRWP fIVES A'NO � ' - <br /> 3u-I I Nb <br /> FIqE 11L�FM REO'L1 RFAS(NJ NDDITIONAI.PIAN CHF.CK — <br /> OTNER <br /> FIRFSPPINKIERREO'D RERS(AJ � � <br /> STATE A�OILDINC.SURCHARCE �� <br /> tii <br /> rroe or roHsr vi nr:r nrvAqvFo ev CITY OF EVERETT �uei ir,woaKs ____ _a0 I O�l <br /> V�i" LOCAL SAIES - - <br /> —h/ onTe L)/9G TAX CODE IS 3105 707nL _ � <br /> -�— <br />