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i �� � <br /> APPLICATIO�1 FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING QIVISION �C����� <br /> 3200 CEDAR STREET• EVERETT, WA 98201 • 259-8810 <br /> 1� DEMOUTION fl COMBINATION fl BUILDING f-1 MECHANICAL 1r PLUMBING f ! SIGN <br /> PROJECT ADDRESS <br /> 02`��/ �it�rcfc�r ����nt� ��=? ��ac�,� <br /> OWNER MRI�AppRE55 CITY Z�� PNONE <br /> �il,2 -S��rua��� �>7�� //�`P/ Sc �,�rp� W.a'. 9�P-lo� <br /> 1GNqNT �ItADpFE55 CITY 71V PNONE �- <br /> _�cc���n/r , �[�'��o�S��e dyc/ r'��d�y, er.ae�✓wq. riA.�i .�Zsd' 3a� <br /> �RCHIT[CT On pE51GNER MA11 AOOFE55 �ITY )IP PHONF <br /> GENCpA�COYtPA�IIXi NAI�qDURE55 Ci'Y 71P Pr10N[ ST�TELICGNSE� <br /> MECNRNICAL CONTRnCTOR M41�ADDRE55 GITY ZIP P110NE SiRTE LICENSE i <br /> fiUA1BING CONTR1f.TOR MEIL A[1DRE55 qLY 21P PMONE $7AiG LICENSE� / -�'�I% <br /> �� .�N,/G<,� �>�u�:;�i� �oac� /a�n���s��S;�,o�f,� W4 98� �v��rv �7P[u+�/�7nP <br /> CONiq�Ci{'pICE OF WOPK <br /> HEATING SYSTEM: ( 1 GAS !l ELECTRIC (1 <br /> DESCRIBE WORK AND SOURRE FOOTAGE INVOLVEO CONTACT PFRSs ND PNOHE NO <br /> ,d.� ,�/f��s . y'-SC7'.� <br /> ..��-��,��r ����- � � s�'� � -�- X��,_ _ �y-a�7y <br /> `�l'7/�j- �?/�V/(2' �/.e iC/�,c/�/' �( 77ju����j�r�� I HEREBY CERTIFV THAT I HA E READ AND EXAMINED THIS <br /> r+norosFoJ�e c euuo}"'c �'+ APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> �{�/�U1110f7� p�{' �'/P �t • PROVISIONS OF LAWS AND OROINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEWLDESCRIPTIONOFPROI'ER1Y1511 WNBELOWORATfFC TwocowEsi NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> tot e�ocK or AU7HORITY TO VIOLATE OR CANCEL TNE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM TME WONK FOR WHICH <br /> APPLICATION IS MADE AND I COMPIV WI�fH THE STATE <br /> PARCELTA%IA.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WA . <br /> CONSTRVCPON IOAN LEN�Eii.ADDRE55.TELEI'HONE NUMAER � LQ�11_ �L�� C�S- <br /> �JI <br /> 9GNR DATE <br /> CITV BUSME55 UC[ C NO <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FlXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATERCLOSET�TOILET) � A/C—lJFiNDLGUNITS—H.P. � <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—DT.U. M <br /> KITCHEN SINK 8 DISP ; CIOTHES DRVERS ; <br /> DISHWASHEF � VENTILATION FAN � <br /> IAUNDRY TRAY ; RANGE HOOD ' <br /> CLOTHES WASHER � WATER HEATER � <br /> � URINAL � WOOD STOVE <br /> GRINKING FOUNTAIN METAL FIREPLACE(WOO�BURNING) <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK (cFRVICE—BAR,ETC.) GAS FANGE � <br /> GAS PIPING <br /> i E%HAUST FAN � <br /> i � <br /> i r <br /> i � <br /> i � i <br /> SUB TOTAL $ � SUB TOTAL $ � <br /> PFqMIT S i PEFMIT $ � <br /> TOTAL FEE $ � TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> �RONiSFTflACK RGARSFT9ACN SIDESETAACN PIpNC11ECNNUM9FR �'f PEf.fIPTNO <br /> usezor+e ioi�nen VACANISITF FEES VALUATION FEE <br /> _�— <br /> fIYES II NO � <br /> _ 011ll DING � <br /> MEIGNT I.IMIIATION NO OF OW[�LING SIZE 0�PLDGT ` <br /> UN175 PLUMPING i <br /> — � <br /> �OUPpNCV NO 015iOR��S p�LUPANI LOAU BRSEMENt MEOIAN!CAL � <br /> I IVES I1 NO — �� <br /> fIREPLARMNE00 Rfn50Y ADDIiIONALPLANCMCCK � <br /> i <br /> '_— <br /> 0111ER � <br /> fIRF5Pf11N1(I[RRFO-D RFACON ' -- <br /> i <br /> 4AlE PUqpING$IIfIC11AqGE <br /> i <br /> ivrFor'r,or+sr rinHsnrvnovener CITYOFEVERETT runnr.wonKv <br /> LOCAL SALES --�-1--- <br /> I „�,i. TAX CODE IS 3105 T07AL __ I <br /> --�— - <br />