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APPLICfaTI� N FOR CONSTRUC'_ .ON PERMIT <br /> CITY OF EVcRETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259•8810 <br /> ❑ DEMOUTION Cl COMBINATION f� BUILDING MECHANICA� f� PLUMBING fl SIGN <br /> PROJECTADDRESS � <br /> �� �i��uT�v �l-A� <br /> OWNER M�ILADURESS CITV ZIP PHONE <br /> An%n�+ Mr�^,��FR 9oi RP-�r,��� �� � � 9s7�3 zsz- � <br /> IENANi MaLA0DRE55 CITY 21P �� <br /> PIIONE t <br /> ARCHITECTOROESIGNEF MAILAOORE55 CITY ZIP PNONE <br /> GENERALCONTMCiOR MAILADDRE55 CIiY IIP PHONE Si�TELICENSE� ' <br /> MECHANICALCONTPALTOP MAILADDRE55 LI7Y IIP PNpNE <br /> G2 STATE UCENSE r <br /> G� <br /> PLUMBINGCONTRF4TOR MRILA�DRE55 CITY ZIP PNONE <br /> STaTE LICENSE� <br /> , CONT CT PRICE OF WORK <br /> : 5�5�• �� HEATING SYSTEM: �GAS fl ELECTRIC f� <br /> �"' ' UESCRIBEWO�NOSWAREFOOTAGEINVO�VED CONTACiPER50NFN�PMONE <br /> � RN <br /> :5. . Q �' Z—' / <br /> . �fiPNACE AN7 �� �A'1.LG�v /�fnlT <br /> � � � I HEREBY CERTIFY THAT I HAVE READ AND ExAMINED THIS <br />. PRO�'OSEDUSEOFBUIIDING APPLICATION AND KNOW THE SAME TO BE 7RUE AND CORRECT.AlL <br /> , � S PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> L:GALDESGRIPTIONOFPROPERTY�SIIOWNBELOWORATT�CH1WpCOPIES) WORK WILL BE COMPLIED WITH WHE7HER SPECiFIED HEREIN OR <br /> NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ��T B�aK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> .;�� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />� , � PERFORMANCE OF CUNSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> PNiCEL T/V(1.0.NUTABER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> z���y�� <br />� CONSiRUCTION IO�N LENDER.AODRESS.TELEPMONE NUMBER � <br /> SIGI�4TUR7 i �— OATE <br /> / <br /> CITY BUSINESS LICENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. 7YPE OF EQUIPMENT FEE <br />� � ' . WATER CLOSET(TOILEn , <br /> A/C—MHNDLO UNITS—H.P, i <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> i <br />� � . LAVATORY(WASH BASIN) � HEAT PUMP � <br /> i � , SHOWER � UNI7HEATERS—B.T.U. M � <br /> I , , KITCHEN SINK d DISP i CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br />� LAUNDRYTRAY � RANGEHOOD � <br /> _ CLOTHES WASHER � WATER HEATER , <br /> URINAL � WOOD STOVE � <br /> DRINKING FOUNTAIN ; METAL rIREPLACE(WOOD BURNING) ; <br />. FLOOR DRAIN � FIREPL�CE INSERT(WOOD BURNING) ~— <br /> BACKFLOW PREVENTERS � GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE , <br /> ' GAS PIPIN6 <br /> r � EXHAUSTFAN � <br /> — ' � <br /> � � <br /> � � <br /> ' � <br />� SUB TOTAL $ , <br /> i SUB TOTA� S , <br /> PERMIT $ , PERMIT S , <br />' TOTALFEE $ � TOTALFEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETPACK RERR$FTBRCK SIDE SET�RCK PIAN CIIECN NUMBfR FEE RECEIPT NO. <br /> .5�21 Z <br /> USE20NE IOTAqEA VqCANi51TE FEES VALUATION FEE <br />, f1YE5 IiNO pUItIIIN(; � <br /> i <br /> IIEIGIITLIMITATION NOOFUWELLING SREOFBLOGrtI � <br /> UNIiS � <br /> FLUMOMG � <br />' O(:CUPANCY HO Of510RiE5 OCCUPRNTLOAD 7RSEMENT � <br /> GROUP M[C11�NIf.AL � <br />' IIYES II NO — i <br /> _ 1 <br /> FIRE ALARM REOp q[ASON ADDI11pNAl.PLRN CH[f,N � <br /> i <br /> i <br /> FIRF.SPRINKLERRE00 RE�SON O1HER i <br /> i <br /> STNE OUILDIYO SIIIICIIAqGE � <br /> 7YPEOFf,ONST PLANSAPPPOVEDOY CITY OF EVERETT �IIOIIC WOtiNS � <br /> LOCAL SALES — <br /> DA7E TAX CODE IS 3105 TOinl ; <br />