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^ <br /> APPLICATIti�l FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOUTION fl COMBINATION fl BUILDING �AECHANICAL f� PLUMBING fl SIGI <br /> PROJECT ADDRESS <br /> l/D � � �� <br /> OWMER MM11100NE55 <br /> �C'iG� AN��soti /o/n cG�BY � "F�c��-rP 9s-r�i z��- �z' <br /> TE/MNT MMt110piE55 Cltt IIP p�qpE <br /> 11PCINTECTIXi0E51GNER MMl11DDRE55 CITY 21P PMp� <br /> GENEMICANTRI�GTOR M�IL�DORE55 qiY 21P PIIONE Si�TEUCENSE• <br /> MrECM�MGICONTMCTOR MA�LADDRE55 (,Y7Y ZIP PNplE STATEI�CEM$E1 <br /> `J� <br /> PLUMBMGCONTR�CTOiI M�IL�DDRE55 GTY 21P Pf1p1E STAfEUCENSf• . <br /> TIUCT VRILE OF AK <br /> S .L?� MEATING SYSTEM: GAS rl ELECTRIC �l <br /> �ESC�M �ND SOU�PE FDOTdGE INVOLVED CONTACT PERSON N!D PlIONE Np. <br /> � Z52-s'/!�/ ' �e <br /> I HEHEBY CERTIFY THAT 1 MAVE READ AND E%ANINED TNIS <br /> P110POSEU USE OF BUILDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND OROINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE CAMPLIEP WITH WHETHER SPECIFIED HEREIN ON <br /> 1EC11LDE5CRIPTIWOFPROPERTY�SMpWNgE�pWppAiT/iGMTWOCpPIES� NOT. THE GRANTIN(i OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot e�oac pF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW RE6UUTINO CONSTRUCTION OR TME <br /> PERFORMANCE OF CANSTRUCTION.THAT I AM AUTHORIZED 8Y TME <br /> OWNEH OF TMIS pROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE ANO I COMPLV WITH THE SYATE <br /> PIWCEITN[ID.MMBER CONTRACTORS UW 1BRI RCW AND 29620'J WAC. <br /> CANSTRIICTION LWW lENOEq.�DpfiESS.iElEP110NE M/MlER ����-� f` -�j�f s <br /> �� 0/,TE <br /> GTY BU91�551ICEN5E Np. <br /> P���� MECMANICAL <br /> NO. TYPE OF FlI(TURE OR ITEM FEE NO. TYPE Of EpWpMENT FEE <br /> WATERCLOSET(TOILEn � q/C-NHNDLGUNfTS-H.P. �— <br /> BATHTUB ' FORCEDAIRSYSTEMS-B.T.U. M E.A. ' <br /> � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNiTMEATERS-B.T.U. M <br /> KITCHEN SINK 6 DISP i CLOTNES DRVERS <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNORY TRAV ; RANGE HOOD ' <br /> � <br /> CLOTHES WASHER � WATER HEATER i <br /> URINAL WOOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIRtPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIpEPUCE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS � GASFIREPLACE ' <br /> SINK(SERVICE-BAR,ETC.) � OAS RANGE � <br /> ' GAS PIPIN� ' <br /> i EXHAUSTFAN � <br /> � � <br /> � � � <br /> � � � <br /> SUB TOTAL f ; SUB TOTAL S ' <br /> PERMIT S � PERMIT S / i <br /> TOTALFEE S � TOTALFEE f � <br /> FOR OFFlCE USE ONLY: <br /> FRONT6EiB/�CK RE�RSETB�LK SIDESETB�CN P�ANCHECKNUMBEii FEE FECEIPTNO. <br /> use zor� toi�r+E� veceNt s�re PEES VALUATION FEE <br /> IIVES �� NQ BUILDING i <br /> � <br /> HEIGNi UMIT�TION NO OF OWELLING SIZE OF 6lOGRl � <br /> UNIfS P��M91N6 i <br /> OLCUVANCY Iq Oi510RIE5 OCCUPANTLO�D BASEMENT � <br /> pqppp MEGN�NIG�L <br /> f7YE5 �7 NO � <br /> FIRE�LARMREOD RF.ASON i <br /> �DD1110N�LPlAN WIECK <br /> OTNEH � <br /> FIRE SPRINetER REOD REASGN <br /> Si�TE BUILDING SURCNARGE <br /> TYPEOFf,ONST P{.ANSAPPROVEDBY CITYOPEVERETT �UBUf,WORNS <br /> LOCAL SALES <br /> ���E TAX CODE IS 3105 TOTAL I <br />