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APPLICATII..d FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STAEET• EVERElI', WA 98201 •259-8810 <br /> f� DEMOLITION �i COMBINATION I l BUILDING I�MECNANICAI f� PLUMBING f 1 SIGN <br /> PROJECT ADDRESS <br /> �O E(i MAILADDRF55 CITY ZIP PHOYE <br /> 3105 �o�,o�r.�u c� C��e�e� 9��oJ '>�3� S S�o <br /> 7ENANT MFILApDR[$5 CITY ZIP PIIONE <br /> ARGHITECTORDESIGNEF MAILR��RE55 CIiY Im GHONE <br /> 3ENERIALCONTRRCTOR MAIL DDRESS CIIY ZIP PIIONE S7ATELICENSE� <br /> S�'�YLcJ�J f�C�Kg� <br /> �AECN:NICALCON �Ct R M�{LA�DRE55 ��n' ZIP MIONE STATE�I�ENSE� <br /> �13I� ��r /�G> /.�k 9� `ri�a��tit�Q 93�/� 67,�-�7�9 c�o�E� �x �ys 7 <br /> �WMBINGCONIRPCT R MaILADD9E5° � CIiY 21P i'HONE STATELI.ENSE� <br /> CCNTMCT PRICE OF WORK <br /> � l`i 3 CD HEATING SVSTEM: ❑ GAS ❑ELECTRIC f7 <br /> DESCIIIBE ORK ANO SOU�RE FOOT�GE INVOLVED I CONTAC PERS N�ND PMONE NO. <br /> ��,a 1 SD ' r �? aT;o.� !- Q iG 7$G <br /> � �n u �/Pr e r; .�, f _ <br /> �7 �.�� Q l I � HEREB� CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> I✓ " � �� �C.rb�Q175i�6 C n.7 ,hate� APPI.ICATION AND KNOW THE SAME TO BE TRUE AN�CORRECT.ALL <br /> PROI'OSEO USE O— F�BV IDIN� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> I�IN� T WORK WILL 8[ COMPLIED WIiH WHETHER SPECIFIED HEREIN OR <br /> LEG�LDES IPTIONOFPROPERTY�SNOWNBEIOWORAiTACHTWOCOPIES� NOT. THE GRANTING OP A PERI,AIT DOES NOT PRESUME TO GIVE <br /> �or BLOCK or AU7HORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTAIf IA.NUMBER CONTRAC ORS lnAW 7827 AND 296200 WAC. <br /> CONSTRUCTION LOAN LENOER.R�DRE55,TELEPHONE NUIdOER X��(��fJ�/(� �—����� <br /> 51 �TURE D�TE <br /> CITV OUSINE55 UCENSG N0. <br /> PLUMBING MECHANICAI <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYP.'-_UF FU(TURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M ; <br /> KITCHEN SINK&DISP i CLOTHES DRVERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD i <br /> CIOTHES WASHER � WA"fEH HEATER � _ <br /> URINAI ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR�RAIN � FIFEPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS i GAS FIREPLACE �_ <br /> SINK(SERVICE—BAR, ETC.) GAS RAt�GE � <br /> GAS PIPING ' <br /> i EXHAUST FAN � <br /> i <br /> � N� • <br /> Gc� e ' <br /> - � ' I <br /> � ' I <br /> SUB TOTAL $ ' SUB TOTAL $ ' <br /> i ' <br /> PERMIT S � PERMIT S �J � <br /> TOTALFEE 3 ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETPACK �[ARSFTBACN SI�ESEiOALN PlANC11ECKNUMDGP FEE RECEIPTNO. <br /> usezor+e �ornnEn vnenrvrsire FEES VALUATION FEE_T_ <br /> � <br /> rnes n rvo ouaoiNc ; <br /> HEIGHTUMITATION NO.OFDWRIING 512EOFBLDGRI. � <br /> � <br /> UN1T5 PLUMOING � <br /> OCCUI'.4NCY NOOGS70FIE5 OCCUPANTlOAO BASEMENT MECHANICAL i <br /> GROUI` <br /> flYES fl NO � <br /> FlPE ALARM FEO'D AEASON AUDIPOYAL PLAN CHECK � <br /> i <br /> OiHER i <br /> fIRESPRIN1:lFRPEOD REASON — � <br /> STATE BUIlOING SURCHARGL � <br /> TVPEOFCONST Pinr,sRrrawEoev CITYOFEVHRETT �U9LICWORKS i <br /> LOCALSALES ; <br /> oqTE TAX COD[IS 3105 TOTAL � <br />