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.rrl <br /> APPLICATION FOR CONSTRUCT ON PERIIAIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259•8810 <br /> fl DEMOLITION fl COMBINATION f ; BUILDING n MECHANICAL rvpy�UMBING f I SIGN <br /> PROJECT ADDRESS <br /> OWNER M�IL�DDRE55 Cltt ZIP PIIONE <br /> _EvE�c.�7r M�.rc a, z-�e� o�.rv �`"��"7� <br />� fENANT MAILADD4ESS QTV ZIP pMONE <br /> %u[L�vC ceFFt'c �a7 cocdv E�f�F-r- <br /> JIRCNIT[�TORDES�GNER MNLl1DDRE55 CIIY �1P PMONE <br /> GENERALCONTRnCTOfi MAILADORE55 CItV 21P PIION[ SiAiEUCENSE� <br /> MECNANIC0.lCONTFACTOR MqILADDRE55 CIiY 71P PHONE ."'EUCENSE• <br />� PLUMBINGCONIRAf,TOR M41�AO�RE55 CITY ZIP PHONE STATELICENSE� , <br /> u r nr �cniw T.co SFi+-�r�E. T6�r ^ -ri rd � <br />� '��G't." conra�crrmce oF wonK /L N. / <br /> I '?p`�' � N�— k.voc✓.✓ HEATING SYSTEM: (l GAS rl ELECTRIC fl <br /> �} t r�`�," DESCPIBE WOpN AND$DUFRE FOOt�GE INVOLVEO <br /> J q�,��P;' GONTACTPERSON�NDPHONFNO <br /> ''.�T; ' -. <br /> ' ;a./:�y,_.. <br /> :',Y�i(�J PLL/M/fINL FY/C I <br />. , 1'ii-/t1 <br /> �� I HEREBY CERTIFV THAT I HAVE READ AN� ERAMINED TH�S I <br /> , PPOPOSED USE OF BUILDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL I <br />, , PROVISIONS OF LP.WS AND ORDINANCES GOVERNING THIS TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEAEIN OR <br /> �� • ' LEG�LUESCRIPTIONOFPROPERTV�SHOWNBELOWOq�TTACHTWOCOPIES� NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />� ` '� . ioT e�ocK ov AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> '� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> t. ,;' <br />` .t . ' PERFOHMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> P�RCEI T�%ID.NUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />� CONSTRU0710N LO�N LENOER.ADDRE55.TELEPNONE NUMBER X � �/—b•• �0%6/Cj� <br /> � Y <br /> SIGN iN�—° DA1E <br />� Cltt Bl15iNES5 LiCENS[NO <br />. PLUMBINO MECHANICAL <br />, NO. TYPE OF FlXTURE OR ITEM FEE NO. 1 YPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—AMNDIGUNRS—H.P. <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br />� SHOWER � UNIT HEATERS—B.T.U. M <br /> KITCF-'EN SINK 8 DISP ; CLOTHES DRVERS ; <br />, ��SHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOO� <br /> � <br /> � <br /> CLOTHES WASHER � WATER HEATER i <br /> URINAI. � WpOD STOVE � <br /> DRINKING FOUNTA'N i METAL FIREPLACE(WOOD BURNING) ; <br />� FLOOR DRAIN � FIREPLACE INSERT(WOOD DURNING) � <br /> BACKFIOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERVICE—BAR.ETC.) � GAS RANGE � <br /> GAS PIPING � <br /> r /L ' i EXHAUST FAN � <br /> � � <br /> � , <br /> � _ � <br /> I , , <br /> _ SUB TOTAL $ � SUB TOTAI S � <br /> PERMIT $ � PERMIT $ i <br />�, TOTAL FEE $ � TOTAL F'eE $ � � <br /> FOR OFFICE USE ONLY: <br />' fRONTSETPACN RERISFTBACN SIDESETB4CK PlqNC11F NUM9GR F[E RECFIPiNO. <br /> usezoNe iornaen v�cavrsiTe FEES VALUATION FEE <br />� IIVES fi NO BWLDING i <br /> i <br /> HEIGMTL�RII7ATION NO.OFOWEtLING SREOFBLDG41 � <br /> UNII$ p���M01NG � i <br /> OCCUPANCV NO Of510R:E5 OGCUPANTL04D BASEMENi � <br /> GfiOUP MECIInNILAI � i � <br />� fIVES fl NO <br /> fIREAURMREOD RF.A50Y AODIIIONAIPIANCNF.CK � <br /> i <br /> Oi11Efi i <br /> FIRF SPRINKI.ER REO'0 REASON � <br /> $fATE BUIL�W6 SIIRCNIRCE � <br /> TVPEOPf,ONST PlANSAPPPOVE00Y � <br /> CITV OF EVERETT runi�cwonKs <br /> LOCAL SALES -�— <br /> onTe TAX CODE IS 3105 7o7aL ', <br />