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'� APPLICATI� FOR CONSTRUCT.JN PERMIT � <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> fl DEMOLITION fl COMBINATION rl BUILDING �j MECHANICAL r 1 PLUMBING f l SIGN <br />' PROJECT ADDRES <br /> --�-�s� Cl��y z� ��cP L'c��/ ��,v�e <br /> owr+Er� ��ooness citt zm rHON[ <br />'� � <br /> IEN�N�o �I�� MAILADORF.55 CITY IIP p110�`JE <br /> �� <br /> ARGHItECTOPDE5IGNEP MMLADORE55 GI7Y ZiP PHONE <br />� <br /> GENER�ICONTliPCTpi M�ILAOI1PE55 CIiV ZIP ��'�ON�S� ��3 iAi[IIC[NSE� <br /> Si(��1�4G F�P�'�5 OG, /,� SZ6� E�/E�'�rr- «n� ;! <br />� MECH�NICRICONTRACTOR MRILADDRE55 Cltt ZIP PNONE STATFUCENSE� <br />� FL�MBINGCONTRRf,TOP MAILAWRESS LITY ZIP P110NE SiATGLICENSE� <br />' CONjPACiPRICEOFWORK <br /> OO GG HEATING SYSTEM: f 1 GAS �l ELECTRIC f-I <br /> �� , DESCRIBE WORK AND SOUPRE fOOTAGE INVOIVED CONTRCT OEPSON AN01'110NE NO. <br /> � o�P�C �/GL S SZ�3 / <br /> � �/5 �� / <br /> , v �O 1 HEREBV CERT�FY THAT I HAVE READ AND EkAMINED THIS <br /> i � � raoro5eou5eoFew�ort+c APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT ALL <br /> I IiAL✓ G���S PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TYPE OF <br /> WORK WILL BE COMPLIEO WITH WHETHER SPECIFIEO HEREIN OR <br /> i ��' LEGALOESCRIPT1pNOFPPOPEFiY(SHOWNBEIOWOqATTqCNTWOCOPIES� NOT. THE GRANTING OF A PERMIi DOES NOT PRESUME 70 GIVE <br />; �� . ior s�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />� � � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br />� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />, APPLiCATION IS MADE AND I COMPLY WITH THE STATE <br /> PARLELTA%I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />�� CONSiRUCTON LO�N LLN�ER.�ODRESS.TELEPHdJE NIIMBER �—�- <br /> ����� � <br /> I SIG RTUF OATE <br /> I , CITV OUSME55 LICENS[N0. <br />�� PLUMB�N6 MECNANICAL <br />� NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EQUIPMEN7 FEE <br /> WATERCLOSET(TOILET) � q/C—MiNDLGUNITS—H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS—O.T.U. M E.A. ' <br /> � � <br /> LAVATORY(WASH BASIN) i HEAT PUMP � <br /> I SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS i <br />! DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD ' <br />' CLOTHES WASHER � WATER HEATER � <br />, URINAL � WOOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAiN � FIREPLACE INSERT(WOOD BURNING) �— <br /> BACKFLOW PREVENTERS � GAS FIREPLACE ' <br /> SINK(SERVICE—BAR.ETC.) GAS RANGE � <br /> � <br /> ' GAS PIPING ' <br />� i EI(HAUST FAN i <br /> � i <br /> � ' <br /> � <br /> 1 � i <br /> SUB TOTAL b � SUD TOTAL 3 ; <br /> i PERMIT S i PERMIT $ i <br /> TOTAL FEE $ � TOTAL FEE $ f � � <br /> FOR OFFICE USE ONLY: <br />� {RCNTSETPACN REARSET�ACN SIDGSEiBACK PI�NCII CKNUMAl:� FEE RECGIPiNO. <br />, ���i��� <br />' usezoNe tornaen V�CRNi51TE FEES VALUATION fEE <br />� <br /> _ r i vEs r i rvo 0111L�MC I <br /> i <br /> HEIGIITLIMIiATION NOOFDWELLING 512EOFBLDGRJ � <br /> 11N11S p��NBINa � <br /> OCGUPRNCY NO OfS�ONFS OCCUPANTl04D BASEMENT i <br />� 0110UP MECNANICAL <br /> f7YE5 11 NO ' – - <br />� FlRERURAIREO'C1 fiF�50Y ApDi;IONAIPiANGi�GCK <br /> �—_ <br /> OTIIER � <br /> FIRESPRINNIERREOD REr1FON � <br /> STA7 E ltUIlOING SIIRCHARGE <br /> i _ <br /> rvrr:oFr,or+sr vinasarrnweoav CITYOFEVERETT rueur,wonks <br /> LOCALSALES — <br /> ppTE TAX CODE IS 3105 TOTAL <br />