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APPLICATION FOR CONSTRUC7 .dN PERMIT� <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOLITION �l COM8INATION �Cl BUILDINO fl MECHANICAL f l PLUMBINO fl 81QN <br /> PROJECT ADDRESS <br /> 3003 G.,. cn-S,No ��-n 'Fa—�3 �N-v <br /> ONNER MAILI�WPESS CITV ZIP PIqNE <br /> 7if� �3oE,N 4 c�. �? o, /�ox 3�07 wr� aIt-�� SEA-r��E' w� , 9/i Ly syz•�339 <br /> TENANT MMLAO ESS f,ITV ZIP PIION <br /> �EiN6• — <br /> ARCHITECTOR�ES�GNER M�ILADORE55 CITY ZIP PNONE <br /> 1�06�,✓� <br /> OENER�LCONTRACIOR MAIL�U�f1E55 CITY IIP PNONE STATELICENSEI <br /> T/IE 13,�-a w c.r'.c- cd , <br /> MECN�HIC/LLCONTR�CTOR M�ILADDRE55 CITV 21P PMONE STATEUCENSE� <br /> PLUMBINOCONTRACTOfI M�IIADDPE55 Cltt ZIP PNONE ST�TELIGENSEI <br /> GqITRACTPRICEDFWORY. HEATINfi SYSTEM: tl(iAS fl ELECTRIC fl <br /> a y�o <br /> DESCRIBE M/OIIK AND SOl1ARE FOOTAOE INVOLVED CONiALT PERSON�N�PIqNE NO <br /> ENGL.oSE C'•g'2� iLr /7�o LQ7NiFA.(� A'STL�'7Bp2s'r'I L- S��r�T <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> vnovoseo use oF euaar+a PROVISIONS OF UWS AND ORDINANCES QOVERNIN6 THIS TYPE OF <br /> O(GIL�[.� WOHK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �a�pEscr+ipnpiocrnprEnrr�srpymee�owon�rt,�cNrvrocor�es� NOT. THE �RANTINO OF A PERMIT DOES NOT PRESUME TO 61VE <br /> �aT B�oc�c o� AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW RE6ULATIN4 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHONIZED BV TME <br /> — OWNER OF THIS PROPERTY TO PERFORM THE WORK WR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 288200 WAC. <br /> PMCEL hVI I.D.NUMBER '� � //J / <br /> CONSiilUCT10N LOAN LENDER.�DMESS.TELEPNONE NUMBCR 5�•��, �'i� "" ' Y/��I N <br /> ��� D�tE <br /> RirlATURE <br /> CITY BUSINE55 LICENFE NO. <br /> ��d MECNANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF FlXTURE OR ITEN FEE <br /> WATER CLO5ET(TOILE� � NC—AMNDL�UNITS—H.P. ' <br /> BATHTUB ' FORCEDAIRSYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY�MASH BASIN) i HEAT PUMP ' <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> CIOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � � <br /> DISHWASHER � VENTILATION FAN ' <br /> � RANOE HOOD � <br /> I � LAUNDRYTRAV � <br /> I CLOTHES WASHER � WATER HEATER ' <br /> URINAL ' WOOD STOVE � <br /> � DRINKINQ FOUNTAIN ' METAL FIREPLACE(WOOD BUPNIN6) � <br /> � <br /> �� FLOOR ORAIN � FIREPLACE INSERT(WOOD BURNINd) ' <br /> �__ <br /> OAS FIREPLACE � <br /> lil � BACKFLOW PREVENTERS � � <br /> T <br />. � SINK(SERVICE—BAR,ETC.) � OAS RANOE ' <br /> � OAS PIPINO � <br /> , E%HAUSTFAN ' <br /> � � <br /> i � <br /> � <br /> � � <br /> SUB TOTAL S ' SUB TOTAL S ' <br /> PERMIT S i PERMIT E � <br /> TOTALFEE S ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FROMSETBACN RE�RSETB�CN SIDESETB�CK PUNCNECNNUMBEP FEE REGEIPTNO. <br /> USEZONE \OTAPEA V�C�Ni511E FEEB VALUATON FEE <br /> f7YE5 fl NO BUILOINO <br /> HE16NTUMIT�TION NUNO_T�UWElUN6 SIZEOiBL00/fl. <br /> /l7 PWIABINO <br /> i� <br /> Q�PANCY NOOi510R1E5 OCCUPANTLO�O B�SEMENi MECNN11CpL <br /> 2 /�� IlYES NO � <br /> �DOI�ION�I PLAN CNECN <br /> FIREAIMMRE00 RE�SON E XS��I <br /> y E� oT„Ea <br /> flliE SPP�NNLER REO'D AEASON ��5�� <br /> / C t STATE9l11lDINOSURLHAAOE <br /> /t <br /> TYPEOFCONST PUN511PPR VE�BV CITYOFEVERETT PUBLICWONNS <br /> " � � M LOCAL SALES <br /> �'- 'V o�TE � � � - j s TA%CODE IS 3105 TOTAI <br />