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APPLICATI�..�1 FOR CONSTRUC7 .�N PERMIT� <br /> CI7Y OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVEFETT, WA 98201 •259-6810 <br /> f 1 DEMOLITION I 1 COMBINATION � BUILGING I 1 MECHANICAL I l PLUMBING f I SIGN <br /> PROJECT ADDRESS � <br /> 3003 Cv, e�+s,N� /'�a. �/S'-s% <br /> owwen Mui�ooi.Fss cm rm rr�oNe <br /> tµE 3��iNc c;. . F e. 6oK '37a� m�5 o�f -/3 , J�r ��T�E, l�a • 9cf/;,y 3y2-�33y � <br /> IEN�N(T� u�iunnness urr rm r��or�F <br /> /J 0 CS'i!V G ' <br /> AN(:NIIECTOR0E514NF.R M�Il�6DRE55 GTv IIP PNONE <br /> �3oE��vf • <br /> OENERALCONTR�GTM MAIL�DOR[SS CITV ZIP PIIOhE SUTEi10E1:5E� <br /> MECN�NIC�LCONTR�GTOR iAA1�ADORF55 CITY TIP PIIONE SUTELiCENS'� <br /> PWMBINOCONTR�CiOR M�II�bORESS CItY ZIP PIIONE ST�TELICENSE/ <br /> CONTMCT PPoCE OF WORN <br /> 2 .nc�o HEATING SYSTEM: I l GAS fl ELECTRIC fl <br /> DESCRIBE WJRN�NU SOU�RE f00 �GE INVOIVE� / � C4NT�CT PfR50N�N�PIIONF NO <br /> l�UiLD�n�G 00�7'�0�,/ av x7� /�,s-oni/1-�, fcfin a/Zst-I <br /> I HEREBV CERTIFV iHAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND COHREf,T.ALL <br /> Piqr'OSEOUSE OFBUIlUINO PROVISIONS OF LAWS AND ORDINANCES aOVERNINO THIS TVPE OF � <br /> /�=/RL� Pa�T�-r�p� �UMP ��vs� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEUUDESCHIPTIONOFPHOPEPTY�SHOWNBELOWON�TT�CN7WOCOPIES� NOT. THE 6FANTINO OF A PERMIT DOES NOT PRESUME i0 OIVE <br /> �or e�ocn or AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER S1ATE OR LOCAL LAW REOULATINO CONSTRUCTION OR THE <br /> PEHFOFMANCE OF CONSTHUCTION.THAT I AM AUTHORI2ED BV THE <br /> — OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE ANU I COMPLY WITH THE STATE <br /> p�qcei r�x i.o.wureeen — CONTHACTORS LAW 18.27 RCW ANP 288200 WAC. <br /> CON5TRUCPON�O�N IEN�EP.�OONE55.TEIEPNONf.NUAIPER x �/� ��y✓� ' ` >/2 I'S' <br /> 51 N11tUqE �' U11iE <br /> CITY BUSINE55lICENSE NO <br /> PLUMIOINU MECHANICAL <br /> NO. TYPE OF FlI(TURE OR ITEM FEE N0. TYPE OF FI�TURE OR ITEM FEE <br /> �— <br /> � WATER CLOSET(TOILET) � A/C—NFINDLO UNITS—H.P. �_ <br /> BATHTUB ; FORCEDAIRSVSTEMS—B.T.U. M E.A. ' <br /> LAVAIORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOI�HES DRVERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAV ; RANGE HOOD i <br /> CIOTHES WASHER � WATE�HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKINO FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FINEPLACE INSERT(WOOD BURNINO) � <br /> BACKFIOW PREVENTERS � OAS PIREPLACE � <br /> SINK(SERVICE—BAR, ETC.) � CaAS RANGE � <br /> ' GAS PIPINd ' <br /> i E%HAUS?FAN � <br /> i � <br /> _ <br /> i � <br /> SUB TOTAL S ; SUB TOTAL S ' <br /> PERMIT S � PERMIT S � <br /> TOTAL FEE E ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONi$E7BACN RFQIEETB�CK SIOESFTB�CK PI�NCIIFC N MPfP �EE RECEIPTNO <br /> USE ZONE ioT�ne� WC�NT SITE FEES VALUATION FEE <br /> �-�E5 �� No a�„��No /U 3�o Id� <br /> MEIOIR LIMIi�iION NO Oi DWF.Ll1N0 512E Oi BLDG?I i <br /> UNITS P��)IAOING <br /> � �OI17�N) <br /> OCCUP�NCV Iq CiS�OPoES OCCUP�NTLO�U BASEMENI MFCN�NICAI <br /> 4 OUP / / � <br /> flVES K� i <br /> FlREIILANMOEO'O RF�SON �00�710N�L1'I�NCHECK I <br /> NJ on�En <br /> FlRESPR�NNLERREO'D RERS(k! - � i� <br /> � � STAIEBl11l�INO5U01:N�RO[ 1 <br /> trPecM coasr rur+serrn Epev CITY OF EVERETT rueuc wonKs <br /> _ / ��n LOCAL SALES <br /> � 'V o�TE/ -'� TAX CODE IS 3105 TOTAL y <br />