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�--�— _ �— <br /> APPLICATI�1� FOR CO�ISTRUG'�ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 • 259-8810 <br /> f� flEMOLITION rl COMBINATION fl BUILDINO �MECHANICAL fl PLUMBINO fl SI(3N <br /> PROJECT ADDRESS ' � ' <br /> � r_ <br /> ��GD.� /,� ) � ��,L') ]O � -«/ <br /> OWNER MMI�DORESS CIIY IIP PNONC <br /> TNL- Bct-.i�� C�D• 3cc,� !a] ('as�.ve 20•E'U a�f1U3 3�2- 7-8�3 <br /> ��y�N� M�II/��R[55 CITY 71 PHONE <br /> �+� 8oe�vir �D�p�yl��t�� �cr�es 45-zzi .�s- q 46-30� 3�z� �8i3 <br /> �F':IniCCTOR0E9�NER MAII�DDRE55 GiY 2���—�PNONE <br /> �ae���ry�(zbZ Suocr�_�7o0 5 c�� t�r�sr �nr,� k�� 9srns3 <br /> OENERAICONTfUC70R MAIL�UORE55� CIiV ZII' PIIONE ST�TELICENSE� <br /> F[ETe<<f�- G4 Nf,R�L-�[/! �U. Navn�,,,«_ ulwy SEau�365'-u�� Era6I0�/c�� <br /> MECH�NiC11LCONTRRCTOR MAIL�WPE55 CIiV r�� �96�33 PNONE A'7�STATELICENSE� <br /> �F �ZM+KII�N COR.P• /.? �/ d•�D AUf_ N Ct�Y��L 9bd31 �eHAQ�-i�AS'r <br /> PIUMBINOCONTR�.CTOP MAIL��URE54 CIfV 21P PNONE SiATELICFN5E1 <br /> M/� <br /> CONTRACT�RiCE OF WOPIt / � ��� � HEATINa SYSTEM: f l QAS I-1 ELECTRIC I-1__ <br /> / ,.�n <br /> DESCRIBE WORR�NO S �RE FOOT�OE INVOLVE� CONT�Ci PER50N�Np PHONE N0 5 T S�' �.I'J <br /> tn�5r.•li- l�'f- )►xp 5y ST4�.t/� Ex— 5 T� � ya�•nt6. 3� <br /> � 1�ueT L�o,i�_ �e d�rnV �w��4 <br /> I HEREBY CERiIFV THAT I HAVE READ ANO EXAMINED THIS <br /> S�E.C�.��l e.T10 h1S — APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> P ED USE OF BIIILdNP PROVISIONS OF LAWS AND ORDINANCES QOVEFNINO THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEO�l0E5CRIPTiplOFPROPERiY�SHOWNBELOWOR�TT�C117WOGOF4E51 NOT. THE ORANTINO OF A PEAMII DOES NO? F'RESUME TO OIVE <br /> �oi e;ocK a AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER SiATE OR LOCAL LAW REQULATINO CONSTRVCTION OR THE <br /> PC-HFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY?HE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV W�TH THE STATE <br /> CONT ACTOHS lAW 1027 RCW AND 288200 WAC. <br /> PIIRCEL TA%I.D.NUMRER '+ <br /> CONSiRVC7�ON LO�N lENOER.�ODRES4,TE�ERIONE NIIMAER <br /> x � (� J(A►'i � 6 - �5 <br /> SION�IURE D�TE <br /> CITY BUS�NE55 LICENSE NO. <br /> PLUMSINd MECHANICAL <br /> NO. TYPE OF FlI(TURE OR ITEM FEE N0. TYPE OF FIIfTURE OR ITEM �E <br /> WATERCLOSET�TOILET) � A/C-AMNDLQUNITS-H.P. ' <br /> �- <br /> BATHTUB ' FORCEDAIF SYSTEMS--B.T.U. M E.A. '� _ <br /> LAVATORV(WASH BASIN) _ � HEAT PUMP ' <br /> SFh�WER � UNITHEATERS-B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES URYfRS_ T_ <br /> i VENTILATION FAl! ' <br /> DISHWASHER ---- � <br /> LAUNDRV TRAV ; RANOE HOOD � <br /> CLOTHES WASHER � WATER HEATEH ' <br /> — � WOOD STOVE � <br /> URINAL <br /> DHINKINO FOUNTAIN i METAL FIREPLACE(WOOD BURNINO) ,T_ <br /> � FIREPLACE INSEHT(WOOD DURNINQ) ' <br /> FLOOR DRAIN � <br /> BACKFLOW PREVENTERS � GAS FIREPLACE � <br /> SINK(SF.RVICE-BAR,ETC.) � OAS RANOE ' <br /> � OAS PIPING —�— <br /> — ' ; E%HAUST FAN .—;— <br /> .—.- � <br /> � <br /> �_ � <br /> i � <br /> � --T <br /> _ J-;--- --- � <br /> SUB TOTAI E � SUB TOTAL S � . <br /> PERMIT f --T PERMIT E � <br /> TOTAL FEE E ' <br /> – TOTAL FEE E ' <br /> FOR OFFICE USE ONLY: <br /> FRONT 5ETP�CK �E�R SETBALN SIOE SETBnCN <br /> PUN NECI(NUMAEII FEF. RECEIPTNO <br /> USE 10NE LOT I1REA V�C�NT SIIE <br /> FEES VALUATION FEE <br /> f1YE5 f1N0 BUIIDINO <br /> HE�OHfLIMIT�TION NOO�OWEWNO SIZEOiBLDO/f� <br /> ❑NITS PWMPM� <br /> OCCUP�NCY NO 0�510RIE5 OCCUP�Ni LO�U B�SEMENI MECH�NICAL <br /> aRWP �— <br /> f7VE5 �l NO <br /> �Oq110N�1 PL�N CNECN <br /> FIRE�IARMREO'D RE�SON <br /> OTIIER <br /> FIRE SPRINNLER REO'� RE�SON ST�TE B111L�IN6 SURCH�R(3f <br /> ._ � <br /> TYVEOFCONST. PUNS% (�O�EDBY CITYOFEVERETT PUBLICWORNB : <br /> qi'1 LOCAL SALES <br /> D�TE - 5 S TAX CODE IS 3105 TOTAL �--- <br />