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� <br /> APPLICATit�N FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> fl DE�AOL.ITION rl COMBINATION I-1 BUILDING �) MECHANICAL y� PLUMBING (1 SIGN <br /> PROJECT ADDRESS (OO Gl. C <br /> � <br /> J-A�22.�1 �(����� U� ��TM �'�� �iRaO( .�5�- �U (p�-� <br /> , <br /> TENANi C M^�ILMORf55 dTY IIP PNOHE <br /> J���� <br /> 11RCHITECi OR D[S�fiNER �M�II AOURE55 G�TV 7�� f'110NF <br /> G iU CONiRAGTOfl MMl RDfME55 G�1 lIP �'��ONC SiRiE I ICENSE• <br />� ,��.�-���C.��o�m-71�� - Qgl'�9 �.�—��o� I�ar�FIr�1H �a ��� <br /> MECN�NIC�L CON nCTOR ^��L pDDRE55 Ci JP PMONG ,i4TE UCF.NSE� <br /> \A m�' <br /> PLUMBMGCONTR�CTOR �l��L 55 GI1Y ZIP PHONE STREIIGENSE <br /> CONTR�C7 PRICE O�WORR � � . <br /> �-. HEATING SYSTEM: GAS �t ELECTRIC �I <br /> DESCH�BE WIX1K�N�SOU�RE fOOT�GE MVOLVED GONT�Ci FEiiSON ANp PNONE NO <br /> � <br /> I � � � � - <br /> ��/� �� � I HEREBY CERTIFV THAT 1 HAVE READ AND E%AMINED THIS <br /> �M1S�' APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> vnorosEou oF e�niaNc PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPE OF . <br /> WORK WILL BE COMPLIE� WITH WHETHEF SPECIFIED HEREIN OR <br /> LEGALOESGN�PTIONOFFAOPERTY(SMOWNBELOWORATfACHiWOCOPIE51 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oi e�oc�c a AUTHOfi1TY TO VIOLATE OR CANCEL TNE PROVISION OF ANY <br /> OTHER STA?E OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PE FORM THE WORK FOR WHICH <br /> APPLICATION IS M D PLV WITH THE STATE <br /> CONTRACTORS LAW 827 296. 0 WAC. <br /> P1IRCEL TI1X I D.MIMBER <br /> CON57RUC710N LOAN LENDER.�ODNE55,TELEPMOHE MUMBER yo 4 x �/�i 94 <br /> sicn�tuae o�Te <br /> an eusn+esc ucer+se No <br /> PLUMMN6 MECMANICAL <br />� NO. TYPE OF Fl7(TURE Oli ITEM FEE NO. TVPE OF FOUIPMENT FEE <br /> ' WATERCLOSET(TOILET) � A/C—AMNDLGUNRS—H.P. ' <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. i <br /> LAVATORY(WASH BASIN) � HEAT PUMP ' <br /> SHOWEF � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP � CLOTHES DRVERS � <br />� DISHWASHER � VENTILATION FAN ' <br />' LAUNDRY TRAV ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> :BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERV�CE—BAR,ETC.) � GAS RANGE <br /> �'-j � _ _ GAS PIPING � <br /> —1— i E%HAUST FAN ' <br /> i I lOSM � <br /> i <br /> i <br /> SUB TOTAL E � SUB TOTAL $ i <br /> PERMIT $ i PERMIT $ �j� � <br /> TOTAL FEE S TOTAL FEE 5 ` ' <br /> FOR OFFICE USE ONLY: <br /> fRONT SF.TPACN RERR SF.TAIICK SIOE SETBALN �lANC11EGK NUMfl[ fEF REC[IPi NO <br /> usezor+e �or�aen v�cnr+�srte F 5 VALUATION FEE <br /> IIVES ff NO � <br /> BUILOING <br /> 11f:IGlli l IMIi/.710N NO Of L�W[LL�N� 5�2E Of BIOGrt I i <br /> UNII$ pI11MOMl. <br /> �_}__ <br /> 1 <br /> OCCUP�NCY NO M S10N15 OCCUPANTLORD PRSEMENT MFC��RNICAL � _ <br /> GPOUP ��IYES �� NO i <br /> AODIIIONAI.PIAN CNFCN � <br /> FlRE AURM REOD Rf RS(YJ �- <br /> OIHER ' <br /> FlRF.Sf'PINRIFRRF00 AFA50'1 � <br /> Sil.t E Bllll pING SI1RC11ARGE ( <br /> rrreorcoNsr rinHsnrrnovaoer CITYOFEVERETT runnr,wonKs _�_ <br /> LOCAL SALES � <br /> uATE TAX CODE IS 3105 TOTAI. <br />