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APPLICATIOr! FOR CONSTRUC7�aN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 99201 •259-8810 <br /> �l DEMOLITlON �l COM9INATION fl BUILDING I-1 MECHANICAL r� pLUMBING I 1 SIGN <br /> PROJECTADDRESS ��� �9 <br /> '/� k�C'll�l.z(r•' <br /> OWNE Mnl�ES$ CITV 2iP pHON[ <br />` � 7/ P! 'JZ'� 7�- <br /> TENIIN AIIADpf1F55 - 1Cltt 71P PI�ONE <br /> C�, ��./� �7i� ��JJ <br /> AR':NITECT OH SIGNER NAIL AUDRE55 Giv ZIP PMONE � <br /> GENERnLCONTPPGTdi MAILAODf1E55 qTY piP P110NE EtA7BtICENSEr <br /> MECHRNICRLCONTPACTOR MAIL.�DDRE55 QP' ZIF p110NE STATELILENSE� <br /> PW CONnTRn�CT^OR / M1ILADDqESS QTV IIP pNONE STAtELICENSE• <br /> /-�/v <br /> iR�CT PRICE OF WORN <br /> HEATING SYSTEM: f l GAS I-1 EIECTRIC f-1 <br /> DESCR19E WORK ANO SOUnR[FOOTAGE INVOLrD CONiACT P[RSON aND PHONE NO. <br /> I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> VROPOSFD VSE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PRCVISIONS OF LAWS AND ORDINANCES GOVERNI�'G THIS TVPE OF <br /> WORK WILL BE COMPIIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESGRIPTIONOFPROPERTY�SMOWNBEIOWOfIRTTACNiWOCOPIES� NOT. THE GRANTING OF A PERMI7 DOES NOT PRESUME TO GIVE <br /> �oT B�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <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 THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTNf I D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRVLTION LO�N LENDER.ADDRE55.TEIEPNONE NUMBER �,��-�� '��(*�{,�� �/ -�' ���( <br /> $6NATUFE ' <br /> DATE <br /> CITY BUSME55 UCEN'�E NO <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE 0►'flI(TURE OR ITEM FEE NO. TYPE OP EOUIPMENT FEE <br /> WA7ERCLOSET(TOILET) � A/C—AMNDLGUNITS—H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> i , <br /> IAVATORY(WASH BASIPI) � HEAT PUMP , <br /> SHOWER � UNIT HEATERS—B.T.U. M <br /> KITCHEN SINK 8 DISP ; CLOTHES�RVERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRV TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER , <br /> URINAL � WOOD STOVE � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE <br /> ' GAS PIPING � <br /> i <br /> � EXHAUSTFAN ; <br /> � , <br /> SUl3 TOTAL $ ; SUB TOIAL $ ' <br /> PERMI7 S J i PERMIT S � <br /> TOTAL FEE S � � TOTAL FEE $ �� <br /> FOR OFFICE USE ONLY: <br /> fRONiSETfiACN PEARSFTBACK SIUESE7ArtCK P�pNC11ECKNUMOER �EE RECEIPTNO <br /> usezoNe lOTAREA VACANiSIfE FEES VALUATION FEE <br /> f IYES �� h0 pWIDINC i <br /> HEIGHTLIMIUTION NOOFDWELl1NG $IZ@OFBLOG41 - i <br /> UNI IG <br /> PlVM01NG � <br /> OCGUPANCV NO OfStORiFS OCGUPRNT�O40 BASEAIENT —�~ <br /> GfiOUP MECHRNICqL i <br /> f1YC5 I1 NO <br /> FlREALAOMREOD {ifASO4 pDDI710NALPLANCNF.C1( <br /> i <br /> �-- <br /> O1M[R <br /> i <br /> fIRESPPINNIERRE00 REASON <br /> i <br /> S1AtE DU�LOING SURCH�qGE <br /> __ �"_ <br /> irreorr,oNst vinNsnr�noveoev qTYOFEVERETT runi.icvmr+es <br /> LOCAL SALES -- ------�-- <br /> oAtE TAX CODE IS 3105 TOTAL <br />