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��_ __ _ <br /> _ ,-. <br /> APPLICATI�.N FOR CONSTR�JC'� �ON PEI;MIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAF STREET• EVERETT. WA 98201 • 259-8810 <br /> �l DEMOLITION 1 COMBINATION yIl BUILDING f 1 MECHANICAL f 1 PLUMBINf3 fl SIGN <br /> PROJECT ADDRESS Z� � � S,S <br /> 3003 G� , C as ��o I ��LD G- YO - , y <br /> ONMER MNl�00R[55 CiLY ZIP PH�r <br /> ,Ll�� [?�o�. ,yG G� , � 06 310� ��s o�- �3 SE,�-� w�F• �rBr2� 3V2-7339 <br /> TENIINT M�I �D�RF.55 f.IIY T—Ii�---f PIqNE <br /> �pE�NG - <br /> �ricwrEcronoesicNcn Mu�.�nnness cm rm PNONE <br /> QL�D�1�6. <br /> OENFMLf,ON101CT(NI MR�I�DPfIFSS f.ITV ]IP PIIONE STATELIJFNSE� <br /> g2ow�r�- con�'r4Nr <br /> Mc�N�NIULCONTR�CTOP MMI�DDRE55 GiV Z�� �'HONE STQF.U:ENSF.� <br /> PIUMBINOCONiR�CTOR b .lA[H1RE55 diV ZIP PNONE STA*EUCENSE/ <br /> CONTMCT PRICE OF WORIt //�9SG HEATIN(i SYSTEM: I -� GAS f� ELECTRIC f 1_ <br /> pESCPoBEWORNl1NO50114REf0pT�g��,IVOLVED CONt�CTPER50N�NpP110NFN0 <br /> F���-A�ft�� Or!'IGL�S <br /> rd�Na�,.,r � M PR�rcr�rr — (o►2sF (..�N��-� cwhQa/1;,��C� 26�-3.�G3 <br /> I HEPEBV CEHTIFV TF1AT I HAVE READ AND EXAMINED THI3 <br /> APPLICATION AND KNOW THE SAME TO BE iRUE AND CORflECT ALL <br /> P{10P09ED VSF.OF BIIILDIN�G� PROVISIONS OF LAWS AND OR�INANCES OOVERNINO THIS NPE OF <br /> WORK WILL BE COMPLIED WITH WHETFIER SPECIFIED HEREIN OR <br /> LE�AL DESCRIVTION OF PNOPENN 151qW1�BE�OW O��TT�CN 7WO LOPIES� NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br /> ipT e�ce� or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STAI'E OR LOCAL LAW FEOULATING CO�'STRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PARCEl1A%I D.NUMBER CONTRACTORS lAW 182/7A/RCW/A'ND 296.200 WAC. � <br /> CONSTRIICPON LO�N LENOER,�DORE55,TELEPHONE NUMBEN J( ' • " ,�� / " ����, �/� � <br /> SIfNA 'JRE �QE <br /> CITv BUSINE55 LICFNSF NO _ <br /> PLUMBINp MECHANICAL — <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE nF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C-AIHNDL6 UNITS-H.P. ' <br /> � FORCED AIR SVSTEMS-B.T.U. M E.A. ' <br /> BATHTUB � <br /> LAVATOAV(WASH BASIN) � HEAT PUMP ' <br /> � UNIT HEATERS-B.T.U. M � <br /> SHOWER � <br /> ' CLOTHES DRVERS ' <br /> KITCHEN SINK 6 DISP � <br /> �ISHWASHER —�- VENTILATION FAN ' <br /> � <br /> � RANOEHOOD � <br /> LAUNDRVTRAY � <br /> CLOTHES WASHER WATER HEATER � <br /> URINAL ' WOOD STOVE <br /> ' METAL FIREPLACE(WOOD[3URNING) � <br /> ORINKINO FOUNTAIN ' <br /> � FIREPLACE INSERT(WOOD BURNINO) ' <br /> FLOOR DRAIN � <br /> BACKFLOW PREVENTERS i OASFIREPLACE ' <br /> SINK(SERVICE-BAR, EtC.) 4AS RANCiE _ • <br /> � 6A5 PIPINO � <br /> E%HAUST FAN ' <br /> � � <br /> i <br /> � <br /> � �� <br /> � <br /> � <br /> � <br /> SUBTO?AL 5 ' <br /> SUBTOTAL S � pERMIf S <br /> i <br /> � <br /> TOTALIFEE S � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: ReceiaT No <br /> iRONT SF.TB�CN REM SETPACK SIDE SETB�f.R <br /> PL�N CIIF.CI(NUMNGf1 fF.E <br /> i� '/,.� <br /> USE IONE lOI Alil� <br /> V�C�NTSI7F. FEE6 Vi.lUATION FEE <br /> f1YE5 �� Nn BUIl01N0 <br /> HEIQMT LIMIUTION NO Of DWELLINO 512E Of B100�f� <br /> IINIiS �. I � PIIIMBINO �- <br /> O�PRICv NO Of SIOFIES OCCUP�NT LU�� B�SEMENT _ < MECIUNIC�I <br /> . I � I1Yf5 1.+'�'1� � <br /> ���I710N�L PL�N C��ECK <br /> FIPE�UNM REO-D �E�SON/ <br /> �S /� l�s��i. OL11ER <br /> i <br /> FIPf.SPRINKLER f.EO'0 RF�S/N! S1ATE BUIIDING SIIRCH�f10E <br /> � s Ff »4 � <br /> TYPEOFCONST PL�NS�P n�e�ar CITYOFEVERETT P��PIICWO�RS � _ <br /> / ��� LOCALSALES <br /> � '�z ' oeiE 3 - �7 '/5 TAX CODE'S 3105 iO7AL <br />