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APPLICATIt�A FOR CONSTRUCT �ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 • 259-8810 <br /> rl DEMOUTION (1 COMBINATION t 1 BUILDING f"1 MECHANIC�IL �!�RLUM5ING f 1 SIGN <br /> PROJECT ADDRESS <br /> owr�p M�ILApDRE55 �j �cin/ zm rHa+� <br /> G �OGt�✓I5 ������, /G,' /l1/P � V �7(�0�� 3v� ���i� <br /> TENANT M� �DpRF55 � / f,ITY 71P PIIONE <br /> ARLMTCGi OR DESIGNCR ��� � � '��� GiTY � ]IP PMONF <br /> GENERALCONiRPCTOR MRIL�D[N1E55 GITY IIP PIION[ STATELICENSE� <br /> MECNANIGALCONTR�CTOR NqI�AM%�F.55 CiiY ]IP PIION[ SInTFULFNSF� <br /> L�'L��!?�/.S�V'k/if��ryc ��LXJr 116�� ��Q� � Jr Z/L?e J�'lC✓vtt�1r�77� <br /> cor�T^Cr rn�c�or vronK <br /> � � �y� HEATING SYSTcM: f �GAS I 1!ELECTRIC ( 1 <br /> OESCRIBE WORK ANO SOWRE FOOT�GE INVOLVED CONTnCT PfR50N ANO P110NF NO <br /> I HEREDY CERTIFY THAT I HAVE READ AND ExAM�NED THIS <br /> PRIX'OSEUUSE OF flUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIO!JS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER ^PECIFIED HEREI�J 03 <br /> LEG�LDESCR�PTIONOFPROPERttISnOWNBELOWOR�TT�GHTWOCOPIE51 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior BLOCK or AUTHORITY TO VIOLATE OR CANCEL THE PROV�SION OF ANY <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTHUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPL ATIO IS MA RND I COMPLV WITH THE STATE <br /> P�RCELi�%ID.NVMBER TRA S LA 8 R A b 296.200 WAC, <br /> /'� / <br /> `9NSTRlICTION 1011N L[NUER.ADDf1E55,iELEPMONE MIMBER �/'— ' / �C <br /> GN�i ATG <br /> CI USM[SS l ICHJSC NO <br /> PLUMBING MECNANICAL <br /> !:� TVPE OF FlXTURE Op ITEM FEE N0. TVPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILEn A/C—AMNDLG UNITS—H.P. ' <br /> BATHTUB � FORCEDAIFSYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASN BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS—D.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES URYERS __�._ <br /> D�SHWASHER � VENTILATION FAN � <br /> LAUNDRYTRAY ; PANG[I100D � <br /> —� <br /> CLOTHES WASHER WATER HEAiER � <br /> URINAL ; WOOD STOVE <br /> ORINKING FOUNTAlN i METAL FIREPLACE (WOOD BUHNING) i <br /> FLOOR DRAIN � FIR[PLACE INSERT(WOOD DURNING) ' <br /> BACKFLOW PREVENTERS � GASFIREPLACE � <br /> SINK(SERVICE—BAR,FTC.) � GAS RANGE <br /> - `�/ ' GAS PIPING � <br /> E%NAUSTFAN � <br /> � ' <br /> � ' <br /> � <br /> SUB TOTAL $ � SUB TOTAL $ � _ <br /> PERMIT 5 � FERMIT $ <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE QNLY: <br /> fRONTSFTPACR pEAp5fT0ACK SIOESETBACN PIANCBECNNUMffFR �[f RfC[IPiNO <br /> usrzoNe imrnen vnc�r+rsre FEES VALUATION FEE <br /> IiYC.S I11J0 � <br /> OUIIDMf, i <br /> ❑GIGHT UMIIAIION NO OP DWELLMCa SIIE Of ALIXi�1 � <br /> UNi7g PLUMFlING ' <br /> � — <br /> OCCUPANCY NO 0�SIOR�LS OCCUPANi lOAO 9ASEMENT M211ANIf.AL � <br /> GROUP _— --- <br /> IIY[5 fl NO <br /> FlREAURMREOD lif450N PfIDpIONM.PI�NG��LCN �_ <br /> i <br /> � <br /> OTNEfi i <br /> FIRF.SPpINKIfI1fiE00 RFAS(R! � <br /> RIRi E 8 W I�INC SURCHMG[ � <br /> � <br /> --�___" <br /> rvreorr.or+st vinNsnrrnoveoev CITYOFEVERETT ruoiir,wonKs ' <br /> LOCAL SAIES — ----- — ---�' <br /> ��A�E TAR CODE IS 3105 TOTAI _�__ _ <br />