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APPLICATION FOR CONSTRUCTION PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOLITION fl COMBINATION fl BUILDINO MECHANICAL i 1 PLUMBIN(i f 1 SION <br /> PROJECT ADDRESS <br /> O �" - / ,eJ .tJ.F' !�i_=- /=tJ.�ii'c/T LU �{'2L� <br /> OWNEH M�Il�p011E5S CITY T1n P110NE <br /> Li=dv�il KA�AA,c��',onJ �pi�- ��.r�r iJ/� i=��,r"i2rlT cr/A 9�Zo � 7 � 3 �� /v7s <br /> IEN�Ni M�II�bDRE55 GTY IIP � PIIONE `� <br /> �RCPotECiOf10E51GNER M�I��ODRE55 LITY )I1' pNpryp �SLI�• ��� � � <br /> ' " rtk�/C'.��j�dn.� S�Sih.tr�s .rv�. /4i3 m�tQ�tv � A .4i' I •/J,c� <br /> ENEfUI LONIMCTOfI M�IL�D[1PE55 f.IIY Z�P PiIONG SfATE IICF E� <br /> / zz•z53�%�F�— <br /> /VMECH�NIGLLONTR�CT01i M�IL�DORE55 G7V ZIP PIIpNE � STAfEII�ENSE� <br /> ( <br /> PLUMBIN6CONTRACiOR . M�IlA0DFE55 GIrY _ _ IIP PIqNE STA7ELICENSE� <br /> GONTtUGT Vp1GE OF MqRk <br /> 3 ,JC� 11EATING SYSTEM: I"x(iAS �l ELECTRIC f l <br /> OESCRIBE NqRN�NO SWAAE FOOT�GE INVOLVEO CONi�CT P RSON�ND PIIONE NO <br /> ✓G i= �'i' � C� t)(� /{ $��t iL� <br /> /JS II n�C C 5 - ,P�! cc — �(.� - - O <br /> I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> VROP09ED USE OF B'/1LDIN0 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNIN�THIS TVPE OF <br /> WORK WILI BE COMPLIEU WITH WHETHER SPECIFIED HEREIN OR <br /> lEOALDE5LPoV7�ONGFP(tOPER71'ISMOWNBELOWOq�TI�CNM'OCOPIES) NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br /> wr e�ocK a AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LMY qE6UUTINa CONSTRUCTION ON THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOqIZED BV THE <br /> OWNER OF THIS PROPEiiTV TO PERFORM THE WORN FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> venc¢i T�i o.rxn�een CONTRAC'TORS LAW 1B.27 RCW AND 298.200 WqC. <br /> LONS71X1GTION LOAN lENOER.�ODi1E58.TFlEv110NE MIMlEP ✓�n. d� � ��� � /�'C�� � <br /> �l� 1dC4 <br /> SION�TURE V OATE <br /> QTY BUSINESS IICENS[NO <br /> K��4 MECMANICAL , <br /> NO. TY/E OF FlXTIME 0111TEM iEE NO. iYR OF ECN/AAtNT fEE <br /> WATERCIOSET(TOILET) � NC—AMNDLOUNIT9—H.P. �— <br /> i <br /> BATHTUB ' FORCED AIR SYSIEMS—B.T.U. M E.A. ' <br /> UVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTNES DRVERS i <br /> DISHWASHER � VENtILATION FAN � <br /> UUNDRY TRAV ; RANOE HO00 ' <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE � <br /> DRINKINO FOUNTAIN i METAL FIREPLACE(WOOD BUFNINO) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNINO) � <br /> BACKFLOW PFEVENTERS ; OAS FIREPLACE ' <br /> i <br /> SINK(SERVICE—BAR,ETC.) � OAS RAN6E � <br /> ' OAS PIPINO � <br /> � EXHAUST FAN , <br /> � , <br /> i i <br /> i � <br /> � � <br /> SUB TOTAL f ' SUB TOTAL S ) ' <br /> PERMIT S � � PERMIT S —� <br /> T01AL FEf. S � TOTAL FEE f '�� <br /> FOR OFFICE U8E ONLY: <br /> i110NTSETPACN AEIIHSFTP�CI( SIOESETBACM PL�NCIIECKNUMflFR �EF NFCFIPTNO <br /> usezor,� IOTAREA V�C�Ni51TE FEES VALUATION FEE <br /> _ nres t� r+o eunowc � <br /> � <br /> IIEIOHTUMIT�TION Noauwe�una ��iteaeioarti , <br /> UNIfS PLUMpINO i <br /> OCCUV�NG� NO(%SI(�N�ES OCCUP�M LO�D B�SEMENT i <br /> ORd1P MFCII�NIC�L I <br /> IIYES �1 NO - <br /> FIREK�pMRE00 RF�SON �DDIIION�I.PI�NCIIfCN j <br /> � <br /> OINER � <br /> qRESPRINNIFRRE00 fIF�F(Y1 <br /> i <br /> Si�iE BIIIIDINfi 511lIf,lUpOE i <br /> i <br /> __ �__ <br /> trveo�tor+sr vinNs�rrnov¢nor CITYOFEVERETT ruenr.won.s ' <br /> LOCAL SALES -- --;-- <br /> ���t TA)I CODE IS 3105 TOTAL 1 <br />