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APPLICATII.N FOR CONSTRUCI .ON PERN6IT <br /> CITY OF EVEFETT• Bi:ILDING DIVISION � <br /> 3200 CEDAR STiiEET• EVERETT, WA 98201 •259-8810 <br /> I l DEMOLITION f 1 COMAINATION I}� BUILDING I I MECHANICAL � 1 PLUMBINCi f I SION <br /> PROJECT ADDRESS �� � j � � � � � <br /> �`(v�� l � -- - <br /> owNeR M�a�nnness r.in �ir rHorve <br /> FlE CUSNi,vC� (�,E�t7�r� � c�A�aK F�,t��� 3��s f�9/2k ot�t�ti W. C'pS�no l-��. 7`fS-�-35d <br /> tEN�NT M�II.�DIMF55 f,I1Y TiP PIIONF <br /> c�'C�e NiTk Sr'crL •v5 ��rL. ..$�r„tK S�-G E✓F,zk7T, ,f/,�. lb2o3 <br /> u�c(w7rr.cronoTesiaNcn M�a�noness � n cirr nr rHo�+e <br /> F-ON �J�sa'���r o�dll I ol1 d� /�x Src 6e CC.��'u�� �i�A • S'G� - C� d.Sb <br /> OENERQCONIIUCIIXi M�IL�OOPGSS CIfV /IP PIIUN[ SiATE1Jf.EHSE� � <br /> ,�M( Co�si, sc✓s 9�9 s���l' SI. n��,��'n l✓a. %�103 G�C�rn+C asi o77�/+� <br /> MECNANIC0.CONTR�CTOR M�IL�DORF.55 CITV 21P PIIONE S�REUCENSE� <br /> �V�� — <br /> PWMBINOCON R�C10R MML�Dbf1E55 CITP ZIP PIIONE StUF.UCENSE� <br /> C <br /> CONTIUCT PRI E OF� <br /> �a� , p-p HEATING SYSTEM: f 1 GAS !-1 ELECTRIC I-1_ <br /> pE$pRIBE VI011K�ND SOU�RE FOOTA�F.INVOLVEU CONT�Ci PFf150N�ND PHONE NO <br /> /�1d,�ti ora,�,e,,, 5„ <br /> f,q�NT STOYz��� !�n'+ � /30s� a Sa�- 5Ga � <br /> I HEREBY CERT�FY THAT 1 HAVE READ ANO [XAMINEII THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND COPRECT.ALL <br /> vn000seo use or evaar+a/�' PROVISIONS OF LAWS AND OR�INANCES OOVERNINO THIS 7YPE OF <br /> In�"9, F�SH�NS Ll��IES J�rORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEO�LDESCPIPTIJNOFPHOI'ERTYI HOWNBEIOWOR�TI— C�_TWOGOPIES� IJOT. iHE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br /> ioT _B�ocK or AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REOULATINO CONSTRUCTION OR tHE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AU7HORIZED BV THE <br /> — OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLV WITH THE STATE <br /> PARCEL TA%IA.MIMPER CONTRACTORS lAW 1827 RCW AND 298200 WAC. <br /> CONSTRUCiION LO�N LENUER.�OCf1E5S.TEIEPNtN1E NUMOER x (// /���/�'�'�'�'�,_ �O �/ZG— y r <br /> SION�LUNE a3 as� ' O�TE <br /> CITY OUSINE55 LICENSE NO <br /> PLUMBINQ MECHANICAI <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF FI%TURE OR ITEM FfE <br /> WATER CLOSET(TOILET) � A/C—AMNDLO UNITS—H.P. ; <br /> BATHTUO ' FOPCED AIR SVSTEMS�—B.T.U. M E.A. +_ <br /> LAVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOV/ER � UNITHEATERS—B.T.U. M ' <br /> KITCHF.N SINK 8 DISP ; CLOTHES DHVGRS _�_ � <br /> OISHWASHER � VC-Ni1LAilON FAN : <br /> LAUNDRV TRAV ; FANOE HOOD ,.T_ <br /> CLOTHES WASHER � WATER HEATER . � <br /> URINAL ' WOOD STOVE ' <br /> DRINKINO FOUNTAIN � METAL FIREPIACE(WOOD BURNINO) �_ <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNINO) ; <br /> BACKFLOW PREVENTERS � OASFIHEPLACE _ � <br /> SINK(SERVICE—BAR.ETC.) � GAS RANCiE _ ' <br /> OAS PIPIN6 �__ <br /> � EXHAUSTFAN � <br /> — � ' <br /> i <br /> � � <br /> � T <br /> SUB TOTAL E ; SUB TOTAL S ' <br /> PERMIT E � PERMIt f � <br /> TOTAL FEE S � T07AL FEE S '_ <br /> FOR OFFICE USE ONLV: <br /> fRONTSFTA�CN Pf:M5FT0�CN SIOES�'B�CIc �UNC11G NUMIEfI FEE RECEIPTNO. <br /> (G`�a,1 — <br /> USF.ZONE iot�ne� v�ceNr srte FEES VALUATION FEE <br /> 11 YES �� N� BUILOINO �,/N � ���� <br /> NEIOHT LIM�T�TION NO OF UWElLINO SIZE O�A100�I <br /> UNITS 76 P�UTAOMC <br /> J <br /> 06G�UP�NCV NOOi5I0RiE5 OCCUPANTl0�0 B�SEMENt � MECII�NIC�I _ <br /> _ � / I1VE5 RNO <br /> �IXN710N�L PUN CHECk <br /> fIRE M REO'0 �1EI15PN �� <br /> N �� O1HER <br /> FIRESlP%RWNLEPP[O� RE�SON <br /> / r< C.r`,[ s.�T[nunoir+a suncH�rrcsE � � <br /> �r� � � y� <br /> TVPEOFCONST PUNS�PPR VFjDBY CITYOFEVERETT �'UPIICWORNS i <br /> �r� LOCAL SAIES <br /> /� /- /� _ o�tE / TAX CODE 1S 3105 TOTAL �_ � � <br /> L_ <br />