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., „�.. <br /> APPLICATIO�V FOR CONSTRUCTION PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STAEET• EVERETT, WA 98201 •259-8810 <br /> i J DEMOLITION Cl COMBINATION f I BUILD�NG I I MECHANICAL I l PLUMBING � I Sltari <br /> PROJECT ADDRESS %i t — � .- ,. , <br /> i � � � c-£%L ,�; >� r�-r/ , ;,, �, :. J � <br /> OYMER MRILAOOfiE55 Cltt ZIP PMpNE <br /> ���1-�,, i� :�-„�r:� l��zl-- ��'ll ;,�1���.�'�#1�- 3i�; �y� t-,.�r� �� � � a%E�<�a <br /> TENANT MRILAbORE55 Cltt Z�P � <br /> AqLNRF.CT qi DESIGNER MnIL f�DD{IE55 C�iV ZIP PHONE <br /> GENER�RL COr1TRAGTOR MWl ROIXIESS TY ZIP i'HOHE STQE UCENSE� � <br /> �Y/GL✓/�l'J� !Cn',i/7.��/GT"/i�...%� �j/'J� �`j� i�9�i/..-�r� ��LGJCi�vIG���i� <br /> MECHANIC�L CONTRep7pR MRILAODRESS CI7V Z17 PNONE StATE LICENSE� <br /> PLUMBINC CONTRACfOP MRIL PDORE55 CITV 21P VHONE STATE UCENSE� <br /> CONTRACi PRRE OF WORK � <br /> `J�C� cc HEATING SYSTEM: I l GAS �l ELECTRIC f7 <br /> DESCRIBE WIFR�ND SOUARE FOOTAGE INVOL CONTACi PFfiSON PNO PN(XJE NO <br /> ;��Y_�_ << ,« ,.j,,� �a1 � ,-� � <br /> /!%�/�/3-T,p�/ -� S�/�i-�a��; _ <br /> �,j;�/(,.s .f j JA�J�� ���C . I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> APPLICFTION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PR01'OiEOU$E OF�11LdN j � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> ��� ����y f� WORK WILL BE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br /> LEG�lDESCRIPT10NOfPpOPEFTVISNOWN6ELOWORATiRGHiWOCOMES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior BLOCK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFURMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTi TO PERFORM TNE WORK FOR WHICH <br /> APPUCATION lIS9 ADE AND I COMFLV WITH THE STATE <br /> PARCFLTA%1 D,NIIMOER CONTRACTORS � 1827 RCW AND 296.200 WAC. . � <br /> CANSTRVCTIONLOANLENDER,ADIX1E59.lELEPHONENUMBER x .✓���� � '� �� ��, �,r�J <br /> SIOyEATURE O�TE <br /> � <br /> ITv AUCINESS UCENSF.NO <br /> PIUMBIN6 MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNiTS—H.P. � <br /> BATHTUB � FORCED AIF SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) HEAT PUMP i <br /> SHOWER � UIJIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES ORYERS i <br /> JISHWASHER � VENTIIATION FAN � <br /> Lr\UNDRV 7RAV ; RANGE HOOD i � <br /> CLOTHES WASHER � WATER HEATER � <br /> UR�NAI ' WOOD STOVE ' ' <br /> DRINKING FOUNTAIN i METAL FIRFPI.ACE(WODD BI�RNING) i j <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD OURNING) � � <br /> BACKFLOW PREVENTERS i GAS FIREPLACE i <br /> SINK(SERVICE—BAR, ETC.) � GAS RANGE � <br /> GAS PIPING ' <br /> � EXHAUSTFAN r <br /> i � <br /> � � <br /> i <br /> � � <br /> SUB TOTAL $ � SUB TOTAL $ ' <br /> PERMIT $ i PERMIT $ � <br /> TOTALFEE $ � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> ('RONT SETBRCK REAR SEtORCK 9�E SETBRCN PLAN CH[CK NUMAER FEE PECEIPT NO. <br /> use zor+e ior neen vnenNr sit� FEES VALUATION FEE <br /> nves n r+o Bui�on+o f � <br /> � <br /> HEIGHTLIMIiAT10N NO.OFDWEWNG SIZEOFPLIXiRI i <br /> UNITS PLU�ABIN6 � <br /> OCCUPAtICY NOOi5T0uiE5 OCCUPAIITLOTO 84SEMEM Nf.CI1nHICAL � <br /> GIIUUP <br /> ❑YES fl NO i <br /> ADDITIONAL PUN CHECK i <br /> fIRE PLAPAI REO'U REASON � <br /> OTMER j <br /> FlPE SPRINKLER REO'D RERSON <br /> STATE Ol11LOING SURCHARGE � � <br /> TVPE OF CON51 PUNS RPPROVEO BY CITY OF EVERETT Pl1B�IC WORNS i <br /> LOCAL SALES —�, ��— <br /> ��q,F TAX CODE IS 3105 TOTAL ..�j ;� �J <br />