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APPLICATIGA FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT•OUILGING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259•8810 <br /> fl DEMOUTION �f COMBINATION I� BUILDING f 1 MECHANICAL r 1 PLUMBING f l SIGN <br /> PROJECT ADDRESS <br /> ao <br /> OWNER M4ILADDRESS IiY Im ` PMONE � .� c�/. 'l <br /> J Ip oC <br /> 7-D � /I?� �zA �l ��ak o�20lnTN pi s �� �yN�v� on 5,_So�! <br /> 1ENANT ) T MMIADpRE55 CITY ZIP F��ONE / <br /> A 1 l 1 N ` <br /> �RCNI r{ngnrq�urv nr.n <br /> _' •••�- Liir Tm rMONE - <br /> �t,'�5f"rfA.'` GcN3t,.�c"f"iti� • <br /> �er+Ean�cor+inncroa MnaaoonEss cirv nr r��oNe srxrEiic��+se.WESTEC* <br /> WESTE AJ ('onis-reuc-t �nr.) '7020 FlJE [. PFF�, J�/ y <br /> MECH0.NICALCONTRACTOR MRIL RDDAE55 CIiV � pIP PH�NE��" ciM&�IC[NSE�F T O�S BC <br /> - 3-9•tilo �� . �-rF San�1�P.0 �a,,;s.� rw i� 3 M_L <br /> PLUMOINGCONTR�CTOR MRILADOAE55 CITY ZIP P110NE SiATELICENSE <br /> I � - 1 *�—�•� c;� <br /> CONTo�r.i PR�CE OF WORK `.` � <br /> �'p7l r� Qd HEATING SYSTEM: ( 1 GAS �ELECTRIC f� <br /> DESCRIBEWdRN�NDS �REFOOTAGEMVOLVEO �pNUCTPf:P50NRNDPNONENO <br /> - r L �c � 8 - / 7 / <br /> C � Z ��� <br /> � N S I HEREBY CERTIFY THAT I HAVE READ AN� EXAMINED THIS <br /> onOvoseo v5E oF e LDING � -�PFLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT A�L • <br /> PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TVP[OF <br /> WORK WILL BE COMPLIED WITH WHETHFR SPECIFIED HEREIN OR <br /> lEGJ1LDE5CRIPTIIXJpFPRpPERTYu�SN�OWcNBELOWORFTfRCNTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior�etocK�L oF /�/AT O F F FP AUTHORITV i0 VIOLATE OF CANCEL THE PROVISION OF ANY - <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE � , :.I:•�r <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE - <br /> OWNER OF THIS PROPERTY 70 PERFORM THE WOHK FOR WHICH ? .L�' <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE � �.`.' II -�� <br /> P�RCEL TAx t0.NUMBER CONTRACTORS LAW 10.27 RCW AND 296200 WAC. � ' � N�4�� <br /> CONSTRUCTION LO�N LENDER.�DDRE55.TFLEPHO� IUMBFR x__i�!/���� //J �j Cf �' .. � ,Y� <br /> O SIGNRTURE D4T[ � �:�pS���,� <br /> HoENiX rt1oeTGA6E 5NEGCEy /i� ��u 2D � • <br /> .�SOu /R&T N S T'. S�U "� I 0 a � Yw CITY BUSWE55 LIC[NSE NO . ����,M.' <br /> PLUM91N6 '�T- MECHANICAL � � ��» � <br /> �� I <br /> . NO. TYPE OF Fl%TURE OR�TEM FEE NO. TYPE OF EOUIPMENT FEE �� i <br /> . WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. <br /> ���BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> VATORY(WASH BASIN) � F:�AT PUMP �— <br /> SH � � NI74tATERS—B.T.U. M �SOO ' � <br /> KITCH K 8 DISP i C THES�RYERS � <br /> DISHWASH � VEN ATION FAN <br /> � LAUNDRYTRA ; RANGE OD � <br /> CLOTHES WASHER � WATER HEA R , <br /> URINAL � WOOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIREPLACE OOD BURNING� � <br /> FLOOR DRAIN FIR[PLACE INSERT( D BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERVICE—BAR, ETG) � GAS RANGE � <br /> _ GAS PIPING <br /> i EXHAUSTFAN ; <br />�i � <br /> � <br /> � ; <br /> � , <br /> SUB TOTAL S � SUB TOtAL 3 ' <br /> PERMIT $ � PERMIT $ i <br /> TOTAIFEE S � TOTALFEE S � <br /> i <br /> FOR OFFICE USE ONLY: G dt _ � ��� <br /> fRONTSFipRCR RGAqSFTB<CN SIDESETBAC� P�l�NGREC NUM R t[F_���/� RECFPTNO <br /> ,�7J )c� ,� j a <br /> usezoNEv Iotnnep vnGnNi97E FEES VALUATION FEE <br />� �+ � IIYES il NO i ' <br /> — BUILDING / �` / <br /> f1' Y <br /> IIEIGIIiLIMITAiION NOOfUWfLLIN(i szeoro�oc�m ; <br /> uNirc `5 '�..610 {- � SG� r�uuowc <br /> OCCVP�NCY 110 0[SIOui[5 OCCUnqNi LOAD BASEMENT I <br /> G OUP A � MCGIANICAL <br /> L �r, f1VE5 U'NO — - <br /> F E�L RM FE00 PPASOY ADUI11pNA�P�pN pIF.CK <br /> N� on�en ' <br /> fIRF.S,PRrINNLERHWD RFASON <br /> I <br /> ry J $iAl[OU1�DMC SURLIIARGE ��(J� <br /> rme or r,or+sT vtnNs a rnoven av CITY OF EVERETT runur.wonKc N <br /> V„� � LOCAISALES - -- —�----- —� <br /> __ nnre - �1 • � 6 TAX CODE IS 3105 7oTAl _ <br /> rs� <br />