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APPLIC/t►TION FOR CONSTRUCTIt�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> Il DEMOLITION fl COMBINATION I-1 BUILDING � MECHANICAL �1 PLUMBING f 1 SIGN <br /> PROJECT ADDRESS <br /> OZIo G dF. � <br /> OWNEP MAIL�DDPES$ LITY 21P PMON[ <br /> �✓�/ /1��Cc� r���� Zo2G �o«rv 9a�zoi 2sz 38iZ <br /> TCNANT MAIL/�pDPE55 CITY IIP P��ONE <br /> �RCNRECTUROESIGN[R MMI.M�qE55 CITV ZIP pNONE <br /> GENERALCONIR�LTpi MAILROIXiE55 QiY )IP pHONG cLAiEI.ICENSE• <br /> MECNRNICAI�CONTf1RCTOR MAI�ADDFESS GTY 21f' PIIpNE STATE UCENSE� <br /> CC_'-7 —� <br /> PLUMBINGCONiRACiOFi MnILADbRE55 Gltt zlP PHONE STATEUGENSE� <br /> CONTiiACT PRICE OF WORN <br /> �.�(o �� HEATING SYSTEM: i GAS �1 ELECTRIC �l <br /> OESCRI6E WOpK AND SQUr1RE POOT�GE INVOIVED GONT T PERSON P PMONE N0. <br /> .,d.qc - 259-�/B7 <br /> -/E/�i c? a2K <br /> 1 HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> P{qPOSEO USE OF BUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALl <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF ' <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�LDESGRIPT�ONOFM,OPERTV($HOYMBELOWqi�TTACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior aiocK or AUTHORITY 70 VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERF�RMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLtCAT10N 1S MADE AND I COMPLY WITH THE STATE <br /> CAPCELT�%IA.MIMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUCTON LOAN LENDER,�DORESS.TFIEPMONE NUMBER x �� �� Z�� /(� <br /> SIAH� OR1E <br /> CITY BUSINE55 LIGENSC NO <br /> PLUMBING MECHANICAI <br /> NO. TVPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> ' WATERCLOSET(TOIIET) � A/C—AMNDLGUNITS—H.P. <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.0 5M E.A. � <br /> LAVATORY(WASH BASIN) i HEAT PUMP � <br /> SHOWER � UNI7 HEATERS—�.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAV ; RANGE HOOD <br /> CLOTHES WASHEH � WATER HEATER , <br /> URINAL � WOOD STOVE <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR ORAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ' 2 GAS PIPING � <br /> i EXHAUST FAN i <br /> � <br /> � � <br /> � <br /> � , <br /> SUB TOTAL $ � SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE $ � TOTAL FEE $ �J�� � <br /> FOR OFFICE USE ONLY: <br /> �RONi SFTPNCk RF.AR SF.TBRCK SIDG SETBRCN t`�pN f.11ECN NUM9FR fFE PECFIPT NO. <br /> u5e ior+e i.oi�aEn v�c�ar site F ES VALUATION FEE <br /> fIYES I1 NO <br /> BORDING � <br /> i <br /> NEIGIIfUMIT�TION NOOFOWRUNG 52EOFOlDGT <br /> UNItS <br /> !'LUMOiNG <br /> OCGUPRNCY NO O�StORi[5 OCCUPANIlOAO BASEMENT I <br /> OROUP MECIIRNILAL I <br /> (lYES I1 NO � <br /> � <br /> FlqEAV1RMREO�O Rfr150N �OOIIIONALPIANCNF.CK � <br /> � <br /> � <br /> orr��n I <br /> cinesrnivKirnneon nenc�r� ! <br /> sTnie Aunowr,sunc�unce � <br /> tvreorr,oast oinasnrrnovenov qTYOFEVERETT naAnr,woeKs --{ <br /> LOCALSALES - — <br /> unrE TAX CODE IS 3105 70TAL <br />