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APPLICATI�1 FOR CONSTRUC�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •258-8810 <br /> fl DEMOLITION fl COMBINATION fl BUILDING UIECHANICAL fl PLUMBING fl SIGI <br /> PROJECT ADDRESS <br /> Z 71 Z (.'Cc�;� �l/E — �� ��'�� <br /> OYMER —. MNL�WqE55 GTY 21P PNpNE <br /> NyN �N�• j'-`-J' _K 'TP'7� r�vc' •���/�/ /�'9r��5�/i�Lf= ��sl }�5—�� <br /> IENANT MIJLADDRESS CITY ZIP p�E <br /> 11RCHITELT Ofl DESIGNEH M�IL AU�PE55 q7y Z�P Plql.,E <br /> � <br /> e - <br /> GENERALCONTMGTOR MMLADORE55 CIIY ZIP PI/ONE STATEIJCENSEI i, <br /> MECMANIC0.CONTR�CTOR MML�DDRE55 CI7Y 21P PMONE ST�TEI�CENSE� <br /> r-� ;; <br /> PIUMBMGCONTP�CTOR MML�DDRE55 qry ' ' ti.� <br /> 2�P PHONE STATE 4CENSE r -' ',ii' <br /> CON �CT PRIC�pFwpn K <br /> ° � ,-� HEATING SYSTEM: f7 GAS fl ELECTRIC �l <br /> DESCRIBE WORNIIND SOUARE FOpTi1GE INVOLVED CONTACT VERSON 11ND PHONE NO j--. .� <br /> �, . Z�G -.S//, <br /> �ti�/flz� j�/� , ,(' <br /> I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED TIiIS <br /> seo use oF euitara APPLICATION AND KNOW THE SAME TO BE TRUE AND CORPEC7 ALL <br /> / �,�j��T ��`��� PPOVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCpiPTIONOFPpOPEqry�SNOwNBELOWORATTACHTWOLpflES� NOt THE GRANTING OF A PERMIT DOES NOT PflESUME TO GIVE <br /> �oi BIOCN OF AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WIiH THE STATE <br /> PARCEL TAII I.D.MIMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTNUCTION IOM/LENOEH,I10DRE55,TELEPHONE NUMBEN ��� //, �� �z -z/ fs <br /> — SNjN�TUF� D�TE <br /> CIiY BUSINE55 tiCENSE NO. ' <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FlI(TURE OH ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WA7ER CLOSET(TOILET) i A/C—/VHNDLO UNITS—H.P. i <br /> BATHTUB � FORCEDAIRSYSTEMS—B.T,U. M E.A. � <br /> LAVATORV(WASH BASIN) � HEAT PUMP , <br /> SHOWEH � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 6 DISP i CLOTHES DRVERS � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER , <br /> URINAL � WOOD STOVE � <br /> DRINKING FOUNTAIN � METAI FIREPLACE(WCOD BURNING) ; <br /> FLOOR DRARJ � FIFEPLACE WSERT(WO00 BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � I� <br /> SINK(SERVICE—BAR,ETC J � GAS RANGE , <br /> ' GAS PIPINO r <br /> � E%HAUSTfAN <br /> � <br /> i ; <br /> � , <br /> � , <br /> � , <br /> SUB TOTAL E � SUB TOTAL S ' <br /> i <br /> PERMIT $ � PERMI7 S /,S � <br /> TOTAL FEE E � TOTAL FEE S p, � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACN RE�q SETBACK SIDE SETBACK p�AN CNEC/K�NUM�BER FEE RELEIPT NO. <br /> l7vJ�/ <br /> usE2oNe �or�ne� vqc�NlSrE FEES VALUATION FEE <br /> IIYES fl NO gUILDING j <br /> � <br /> NEIONTLIMItAT10N NOOFOWELLINC SIZEOfBLOGRI — <br /> llNlfS • � <br /> PWM01N0 � <br /> OCCUPANCV Iq Oi5I0RiE5 OCLUPANiLO�D BISEMENT � <br /> GRWP MECM�NIC�L � <br /> f1YE5 fl NO � <br /> � <br /> FIRE�LARMREOD qGA50N ADDIfIONR�PlANC11EC1( � <br /> OIHER I <br /> I I KLEPHEO'D REASON <br /> � <br /> SiAIE BUIIDING SUFCH�RGE � <br /> i <br /> TYPEOFf,ONST PLANS�PPHOVEDBY CITYOFEVERETT �110LICWORKS i <br /> LOCAL SALES <br /> DATE TAX CODE IS 3105 TOTAL <br />