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� I <br /> APPLICATIO�.1 FOR CONSTRUCT_ �N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> i <br /> fl DEMOLITION Il COMBINATION i I BUILDING f 1 MECHANICAL i�fi PlUM81NG fl SIGN <br /> PROJECT ADDRESS <br /> /��� - �'��>' , <br /> OWNEH MRILADDRESS CITY Zi�' PMON[ <br /> j j«/G Gr/�u�'-I� l�3 z� - /�r s,— ��.;� ��I�>- �;�" C y,, . � �, ��� �J�E c��� , <br /> �ENANT MRILADORESS CITV 71P PNONE <br /> RRCMITEGT OR pE51GNER MAILRDORE55 LItY i1P pHpNE <br /> GENERALCONTRnCiOR MRILPDORE55 CITY 71P PHpNE 1 JST�TELICENSEt • <br /> /'r/L (��.%�Y7 � G:;��/S��2c�L7'�C�,-v — S.�Jy"1c'_ ,��" /9��i'!/�l/t�/LL/G Y,'C�Gf:�j,� <br /> MECNRNICALCANTpACiOR MAILAOORESS CITY ZIP PIIONE STATEIICENSE� <br /> PIUMBING CONiR�CTOR MAIL AODRESS CITV 21P PNpNE SiATE LICFNSE• I <br /> 1�t_T����� i'Lc/�'/LP.n/l� J£.e <br /> COYTRACT CpICE OF WORK <br /> HEATING SYSTEM: ItI4,AS �i ELECTRIC I-1 <br /> D[SCR@E WORK ANp$pUARF�FOOT�OE INVOLVEO CONi�CT PF.RSOY F4D PIIONE NO <br /> —�_- %Gt-�i`�l3 !�� [/SG =!� ,'.��/�/-��"/ _`, <br /> Z ,� �- -�. v ,�fJ t� -, <br /> , �_, <br /> I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> rnoroseo use o�m�owo APPLICATION AND KNOW THE SAME TO BE TRUE AN�CORRECT.ALL <br /> j/��/� ��' �p.�/� � PROVISIONS OF LAWS AND ORDINANCES GOVEFNINC THIS TVPE OF <br /> � ��� � WORK WILL BE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br /> LEG�L�ESCRIPfIONOFPROPERTY�SNOWNBFLOWORAiTACHiW0001'�ES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESIIME TO GIVE <br /> ior n�ocK oF AUTHORITY TO VIOLATE OR C.4NCEL THE PROVISION OF ANV <br /> OTHER STATE Ofi LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT�AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS ,/ApE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I U NIIMBER CONTFAC�OFS UA � .27 RCW AND 296.200 WAC. <br /> �3 ���� - 3 ��� _oG3 �- Or'C' ,�� ' ' � � <br /> CONSTRUCTION LOI�N IENUEP.PUURES3.TEIEPHONE NUMBER X �/j/ �' J�.' Z � ' / <br /> SIGN URE DRTE <br /> CITv EUSiNE55 I�GfYSE N0. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF flXTURE OR ITEM FEE <br /> �j WATERCLOSET�Ti)ILEi) � A/C—A/HNDLGUNITS—H.P. � <br /> � BATHTUB � FORCEOAIRSYSTEMS—B,T.U. M E.A. ' <br /> I LAVA70RV(WASH BASIN) � HEAT PUMP � <br /> / SHOWER � UNITHEATERS—B.T.U. M � <br />. KITCHEN SINK 8 DISP i CLOTHES DRVERS i <br />� DISHWASHER � VEIJTILATION FAN � <br /> I LAUNDRVTFAV ; RANGE HOOD � <br />� CLOTHES WASHER WATER HEATER � <br /> URINAL � WOOD STOVE � <br /> ORWKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) i <br />� FLOOR DRAIN � FIREPLACE INSEPT(WOOD BURNING) �— <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERVICE—OAR,ETC.� � GAS RANGE ' <br /> GAS PIPING <br /> i EXHAUST FAN � <br /> i i <br /> — i — <br /> i i <br /> i i <br /> i i <br /> SUB TOTAL $ ' SUO TOTAL $ ; <br /> PERMIT $ � PERMIT $ i <br />� TOTALFEE $ � TOTAIFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBnCK RERF SFTBACK SI�E 5ETBRCN PUN CNECK NUMOHP FEE RECEIP7 NO. <br /> uSe20Ne toi�nen VRCANTSITE FEES VALUATION FEE <br /> nres ri eo euaon+o i <br /> i <br /> HEIGNT 41MITATION NO OF Uw[LIING SIZE OP ALD(i.rtl. � <br /> VNITS p�UM91N4 i <br /> IX:CUPANCV NO O�Si0�IE5 VGCUPAN7LOA0 B�SEMENt � <br /> GROUP MECN�NICRL � <br /> ❑Y[5 fl NO <br /> � <br /> FIRE ALARM REO'D liEASON AUDIPONAL VLAN CHECK I <br /> OTHER � <br /> FlRE SPRINKIEq REO'0 PERSON � <br /> S1AlE BUILOING SURCHAROE i <br /> I <br /> TVPEOFCONST PUNSAPPROVE�BY CITYOFEVERETT POBLICWORKS � <br /> LOCAI SALES � <br /> DnTE TAX CODE IS 3105 70TAL I <br />