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- <br /> .. �, <br /> APPLICAT16r1 FOR CONSTRUC7 .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259•8810 <br /> fl DEMOLITION yd, COMBINATION f� BUILDING I-1 MECHANICAL t� pLUMBING �l SIGN ' ' <br /> PROJECT ADDRESS <br /> '11 Z-2 GUL('' f1ti'� • `7It,411 � �) ') lii�d���T LL'l1 � 7-v � <br /> OWNER MMLADDRE55 p}y . <br /> r�L�r�=n�,�'i �r�o��C-�S,��,�, �� , � . �� . �.��x2��� ���,���-rz T i r��P� q�za G� <br /> TEN�NT x1qILl�ODRE55 CITY <br /> IIV PNONE <br /> ft,11�.ti��w.r.irf hc,Aizk cfr�7f:;t=- 2��'ZCr���'I"f�,'f Ck,'�i�t��T 6Ll�'f�z;:l �o � a^_ <br /> PRCHRECT OR OESIGNER MRII AODBE55 pTY )IP � PMONE ��1 O ���� <br /> , ��, �s�r.-� �,�^�:�u 2? o���z - � �-w�a.�- ���,w��ila,c� T�r�� �vl�`ir���13(��h�G� <br /> G L CONTMCiOR MAIL�0� E55 /� CI�Y n Zi� �J�ONE ciAT@ LICGNSE r <br /> .L4YJ('ti9� ��-n� . 9�i.3�/'/7 � �'�z��n f7VL � 3U�1 .�/n� -/oSr� '05,,?� <br /> MECl/ANICALCONTRACidil MAI�AD�RE55 CITY ZIF PHONE STATELILENSE/ <br /> �70� ��'7 �o A�/� � � r� �-�� <br /> PL'JMBINGCONiRA�TOR MAILA�DRESS CIN ZIP PHON[ STATEUCENSE� �� <br /> CON �CT PRICE OF WORN �— <br /> � �QO�p�Q . UU HEATING SYSTEM: ( 1 GAS I-1 ELECTRIC fl <br /> DESCHIBE WORK ANO SOU�RE FOOTAGE INVOIVE� CONTACT P[Ii50N RNO PHONE N0. <br /> z: -� �� �. ', ., I ' � �` - �C ^ - ( 7� <br /> �7(r�5 LC1it�Al?�L� `:Y6.F� <br /> 1 HERE9Y CERTIFY THAT 1 HAVE FiEAD AND EXAMINED THIS <br /> PROPOSEOUSEOFBVII.DING APPLICATION AND KNOW THE SAME TO BE TAUE AND CORRECT ALL <br /> PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � �� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED NEREIN OR <br /> LEGIIL��DE"SC'RI�PTIO"NOFPPOPERTYII�SNOIVNBELOWORATTPCNTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PqESUME TO GIVE <br /> ior_u�t,v e�ocK `G,r�_or_ AUTHGRITY TO VIOLATE OR CANCEL iHE PROVISION OF ANY <br /> OTHER StATE OR LOCAL LAW REGULATING CONSTRUCTION UR THE <br /> A� � �N '- 4� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE � <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS M/L1D AND I COMPLY WITH THE STATE <br /> PARCEITA%10.NUMBER CONTRACTOR. AW�q.2 RCW AND 296200 WAC. <br /> ��� o <br /> CONSTRUGTIONIO�NLENOER.ADDRESS,TElEPHO.ENUMPER X U I� .C�c� <br /> SIGNATUPE � OAT- I <br /> CITY�USINE55 LICENSE NO <br /> PLUMBING MECHANICAI <br /> NO. TY'PE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOIL�n � q/C—AMNDLGUNITS—H.R � <br /> BATHTUB � FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWEF � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAV ; RANGE HOOD ' <br /> � <br /> CLOTHES Wl.SHER i WATER HEATEti � <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BUFNING) � <br /> FLOOR DRAIN FIREPLACE INSERT(VJnOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIRFPLACE ; <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE � <br /> ' GAS PIPING ' <br /> i ERHAUSTFAN � <br /> � <br /> � � <br /> � <br /> � � <br /> SUB TOTAL S � SUB TOTAL 5 ; <br /> PERMIT S i PERMIT S � <br /> TOTALFEE S � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETPACN REAASF.TBALK SIDESETBACR PIANCIIECR M fP FEF �� RECEIPlND. <br /> / <br /> usEZONe IOT�RFA vncnrvisrtE F ES VALUATION FEE <br /> fIYES f1N0 OUIL��Yp �� �/� , �D <br /> , <br /> IIEIGIIiLIMITATION NO.OFOWEWNG 512EO�B1013Rl � <br /> UNIf$ �� p�pN[fING � <br /> { <br /> OCCVPANCV Np Gf S�OFI(5 OCCUPANT lpp0 BASEMENT MECII�NICAL � <br /> CROUO / <br /> I IYES yl NO � - <br /> PIIiEAURMREO'D RFAS N f ADDI110NALPLANCNECK � <br /> F.S /IQL L� �n0/N'IJ�Fi� on¢n ; <br /> ��me;raiNK�ennEan nEnsor+ -- <br /> L � <br /> y�'S (�dC �/iZQ/r✓j��✓�✓ s.niE omioir+c suacnnnce 1.7 rj <br /> n�reorr,ovsi rtnNs rr+dveonr CITYOFEVERETT runucwonHs <br /> I �q � //�� LOCAL SALES <br /> l� ��q�E� _� _�r TAX CODE IS 3105 TOTAL <br />