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.� - <br /> APPLICATIOt�. FOR CONSTRUCTI�..N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISIOM <br /> 3200 CEDAR STAEET• EVERETT,WA 98201 •259-8610 <br /> ❑ DEMOLITION ❑ COMBINATIUN O BUILDING �C3' MECHANICAL f-I PLUMBING f-I SIGN <br /> PROJECT ADDREF.S � <br /> L�ZS Coc.�,� df/--. c�. 3��z. �-atin- <br /> OVMFA MULA00RESS GTv 2iP PMONE <br /> �711�t- /'-,�'%. O•!-'•G+�sl:X y.�i Y C-�'i, �'���6 <br /> TENANT MAllA0DpE55 CITV ZIP PMONE <br /> MCNITECTOi10E51GNER MAILADORESS LI7Y 21P PNONE <br /> CaENE1LLLCONIRACTOR MAIL�DDPE55 GITY ZIP PMONE STATEUCENSEI <br /> MECH�NICJ1LfANTPACiGR MAILADDPESS CITY ilP PHOIiE ^uTATEUCENSE� <br /> �Gza• �•� s��� �c�,�F /l,�fvrGyz•a/Y �J�- 9�, `b"�:�rr�- Ez�ssi1�.t-� <br /> GIUMlINOCON7R/�CTW1 M�ILdDDPE55 QTV 21P PHONE '3TKELICENSEI <br /> CONiMCT PRICE OF WOAF <br /> �b vy _ HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> OESCR19E WORK MID SOUAqE FOOTAGE INVOWEO CONT�CT PERSON ANO PlqNE N0. <br /> �/ T.f/ {��'G<%L�.t�il` �i/✓G� _ <br /> I HEREBY CERTIFY THAT I HAVE REhD AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSED USE OF BU�LUINO PROVISIONS OF LAWS AND ORDINANCES GOVERNINu THIS TYPE nF <br /> �DI�Y�s.S."i��i� D�7Gf WORK WILL BE COMPLIED WITH WHETHER SPECIHED HEREIN OR <br /> �a�oescwvna+oFrno�Atrlsaowr+ee�owon�necarnocories� NOL THE GRANTING OF A PERMIT DOES NOT PRcSUME TO GIVE <br /> �o� e�ocK oF AUTHORITV TO VIOUTE OR CANCEL TNE PFOVISION OF ANV <br /> OTHER STATE OR IOCAL LAW RE6ULATIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONST!iUCTION.THAT I AM AUT1lORIZED BY THE <br /> OWNER OF THIS PRf1PERTY TO PEHFORM THE WOf'K FOR WMICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> P�qCFLTAII I.D.NUMlER CQNTRACTORS LAW 1827 RCW AND 208.200 WAC. <br /> CdIB111VCTION LOAN IENDEM.ADDRESS.TELEPIIONE MJMlER X��71p� /L-L`3-9'�r" <br /> SIGNATURE r D�TE <br /> C17Y BUSINE55lICENSE N0. <br />, p�p�pp MECMANIC�L <br />� NO. TYPE OF Fl%TURE OH fTEM FEE NO. TYPE OF Fll(TURE OR ITEM FEE <br /> WATER CLOSET(TOILEn � AIC—NHNDLG UNITS—H.P. ' <br /> g�TM7Ug ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP ; CLOTHtS DRYEFS � _ <br /> DISHWASHER � VENTILATION FAN ' <br /> UUNDRV TRAY ; R/�NGE HOOD � <br /> CIOTHES WASHER � WATER HEATER � ' <br /> URINAL ' WOOD STOVE ' <br /> ORINKINO FOUNTAIN i METAL FIREPLACE(W90D BURNING) i <br /> --� <br /> FLOOR DRAIN � FIREPLACE INSERT(WOJD BURNING) ' <br /> BACKFLOW PREVENTERS ; GAS PIREPUCE � <br /> SINK(SERVICE—BAR,El'C.) � GAS RANOE ' <br /> � GAS PIPING � <br /> , EXHAUST FAN ' <br /> i ' <br /> � <br /> � � <br /> i <br /> SU6 TOTAL S ' SUB TOTAL f ; <br /> PERMIT S i FERM�T 5 � <br /> TOTALFEE 5 � TOTALFEE S ' _ <br /> FOR OFFICE USE ONLY: <br /> ppppfyE7gI1LY( REMSETBALN SIDESETBACK PL�NCHECKNUMBER FEE RECEIPTNO. <br /> usezo� �oree� VAG�NTSITE FEES VALUATION FEE <br /> ❑VES ❑ � BUIlDINO i <br /> MEKiHT IJMT�TION NO.OF DWELl1N0 &g OF Bl�(3/LI. i <br /> ❑NITS PLUIdBIN6 � <br /> pCLUPANCV NO.OfSTOPoFS OCCUPANTLOIID BASEMENT MELHANIC�IL <br /> G�� OYES ❑ NO � <br /> FlIIEAURMREO'D RE�SON ADdItON�LiMNCHECK � <br /> OiN[H i <br /> FIRESPR�NKIENNEOD REAS�N � <br /> STATE BUILDING SURCHAF. � <br /> � <br /> nae oF cor+sr. vur+s�nrnovEo ev C�y OF EVERE7T PUBl1C WORKS I <br /> LOCAL SALES ' <br /> o�TE TAX CODE IS 3105 TOTAL <br />�s� <br />