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.�� <br /> APPLICATIt,N FOR CONSTRUCI .ON PERMIT� <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STR[ET• EVERETT,WA 98201 •259-8810 <br /> f7 DEMOLITION fl COMBINATION fl BUILDIN4 MECHANICAL �l PLUMBING I� SION <br /> PROJECT ADDRESS � (� <br /> •' '�_ <br /> en M�IL�WDRe54 cm zir( ^ rrror�E <br /> •NT MAILADIXIE�-�1-L--�Q`/i+�Ll�. ��i� �d l PIIONE3�t � -�33� <br /> ARCNITECTORDE ER M/JLADDRE55 GIIY 11P PNONE <br /> OENEPALCONTR�CTO{i M�IL��OPE55 CITV Zi� f110N[ STA�El10ENSE/ ♦ <br /> MECNANICALCONTRACiON AUIl�00RE55 CITY 2�P `IbDIP,r O ST�TELICENSE� <br /> �trr,o�h��,r (' �,►t� t��i � ►Y1n ��u /1� Kc�,T �1�t�32 S " 1�e►�rY�ac_.�� i`�NT <br /> PLIIMBINO LONTN�CTOR M�IIhODRE55 CItY ZIP PIIONE STATE LICENSE� <br /> CONTRACT GRIGE OF VIORN <br /> HEATING SYSTEM: GAS f7 EIECTRiC Cl <br /> RIBE WORI(�NU SWARF FOOT/�OE I OLVEO CON CT PENSON A O VHONE NO <br /> l \ � C � <br /> � � — <br /> , 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PIqP09ED USE OF BUIIDINA PROVISIONS OF LAWS AND ORDINANr,ES 60VERNINa THIS 7VPE OF <br /> WORK WILL BE COMPIIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEQ�LOESCRIPTIONOFPNOPERTY�SHOWNBElO\Y09�R�CH7N'OCARES) NOT. THE ORANTINd OF A PERMIT DOES NOT PRESUME TO OIVE <br /> �ot etoc■ oc AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAI LAW REQULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICN <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> veacE�iuc i.o rruuaen � CONTRACTORu LAW IB27 RCW AND 298200:YAC. <br /> LONSTIMICTION LO�H IENDEN.�OW�ESS.TELEVIqNE NUMBER X I l !�M n�� ] � L�i� � � � ���V <br /> 51 �TURE � O�TE <br /> Cltt 9U9NE55 LICENSE N0. <br /> y���Np MECHANICAL <br /> NO. TYPE OF FlI(TURE O!1 REM FEE N0. TVPE OF FlXTURE OR ITEM FEE � <br /> WATER CLOSET(TOILEn � A/C—AMNDLO UNITS—H.P. � <br /> BATHTUB i FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> UVATORV�JVASH BASIN) i HEAT PUMP � <br /> &HOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES ORYERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRVTPAY ; RANQEHOOD i _ <br /> CLOTHES WA°HER � WATER HEATER ' <br /> URINAL ' WOOD STOVE ' <br /> DRINKIN6 FOUNTAIN � METAL FIREPLACE(WOOD BURNINO) <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNINO) ' <br /> BACKFLOW PREVENTERS ; OAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � QAS RANOE ' <br /> � QAS PIPINO � <br /> , E%HAUSTPAN � <br /> � <br /> � ' <br /> � � . <br /> � ' <br /> SUB TOTAL S ' SUB TOTAL S ' <br /> PERMIT S i PERMIT S � <br /> TOTALFEE S ' TOTAI.FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FBOHfSETBACK PE�PLETBACK S�DESEiBACR PIANCHEC/N_NUM/B_ER FEE ItECE1PTN0. <br /> i��U� <br /> USF.Zd1E IOT�REA V/�CANT SITE FEES VALUATION FEE <br /> f1YES �7 NO g�ILDIN6 <br /> HEIAHTl1MITATION NO.OFDWELUNO SIIEOFBLOO/TI. <br /> UNITS P�UMBINO <br />, pCCOUPANCY NOOi4TqtlE5 OCrUWJliLOAU B�SEMENT MlCIIN1ICN <br /> ❑YES fl NO <br /> FIREAlA11MRE0'O RE�SON �OM110N�LVlAYGNECK <br /> OTHER <br /> FIRE 6PPINRIER REO'D NEASON <br /> STATE BURD'NQ SUi1CH�P0E <br /> TYPEOFCONST PUI:SM QVE�BY CRYOFEVERETT FUBLICWORNS <br /> iM� LOCAL SALES <br /> o�te 1 — S TAK CODE IS 3105 TOTAL <br />