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APPLICAT16�i�! FOR CONSTRUCTrON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 9E201 •259•8810 <br /> fl DEMOLITION �l COMBINATION Il Bi11LDING f-1 MECHAhlCAL �PLUMBING fl SIGN <br /> PROJECT ADDRESS ,� � <br /> c� �7 5 � � <br /> � .�f:�-, ct��. -��..�{z " ��., y �r,`c,.e� <br /> OWN�� S ^ � M�l/�pPE55 CITV <br /> !%/ . / 2i� �NONE <br /> i--'t <br />' TENA�L� MAILpppRFFS CITY __ <br /> � IY.s . U� <br /> Z�P FNONE <br /> )-y'iVN:� <br /> ARCNRCCTORDESIGNER MMtA�ORE55 ��n. <br /> 71P PMONF <br /> GENEpRLGONTRA�tIX1 MAILRpDPE55 dIY -- <br />� 7�� PIIONE $fATE LICENSE• <br />� MEp1IWICALCON'RA�TOR MnIIADDAESS ��n. <br /> Z��' PHONE SIDTE IICENSE� <br />� ��}y PqLOMBIN CONIR�/f,7pR � ///� MAILADURE55 <br />' -`^"' P��/'^�Lb't+ ['-1! . IU�- CI� 21P PNONE STATG UCENSE� I <br /> �. �� S'k.,�,...0 ,, �, ���� y � s6s-���� � � zrs - �i_ �p <br /> LONTRACT PRICE Oi WORK <br /> , : HEATING SYSTEM: I l GAS ! 1 ELECTRIC f� <br /> i f � OESCRIBE WORK� D SOV9AE FOpT�GE IN �yED / Q CONiACT PERSON ANO PIIONE N0. <br /> i ;e,i`�,'• �.LM ( /�`.(�WZ <br /> I ..t'� _ <br /> I :*' _ <br />' 1�'�� I HEREBY CERTIFV THAT 1 HAVE READ AND EXAMWED THIS <br />��, ��la..':. �: PROPOSEDUSE GF BUILDINO APPL�CATION AND KNOW THE SAME TO BE TFUB AND CORRECT ALL <br />' -' - . PROVISIONS OF LAWS AND ORD�NANCES GOVERNING THIS TYPE OF <br /> LEG�LDESCRIPTIpNpFpROPERiY�SNOWNBELOWOpATT�CMTWOCOPIES� �'�'UHK WILL BE COMPLIED WITH VJHETHER SPEGFIED HEREIN OR <br /> i NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> `� � �oT e�ocK or AUTHORITY TO VIOLATE OR CANCEL THE PqOVI510N OF ANY <br /> ''�I� ,� - OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />� "�' "'� PERFORMANCE OF CONSTRUCT�ON.THAT I AM AUIHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PAACELTA%I.D.NUMBER CONTRACTORS LAW 1B.27 RCW AND 296.200 WAC. <br />� CONS7AUGilONIOANLENDER,�UDRE55,T[LEPNONENUMUER x��-�� l ��/�` /U�3U- /`S <br /> �_��i� N a i 7 <br /> SIGN�TURE ORTE <br /> CIiV BUSINFSS LICENSB N0. <br />�� � PLUMBING MECHANICAL <br /> t � � NQ. TVPE OF flXTURE OR ITEM FEE NO. 7YPE OF EQUIPMENT <br />� � ����� WATER CLOSET(TOILET) FEE <br /> I ' A/C—MiNDLGUNITS—H.P. <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. ' <br /> � <br /> i �_ LAVATORY(WASH BASIN) � <br />� � HEAT PUMP <br /> SHOWER � <br />� ' UNIT HEATERS—B.LU. M � <br /> . KI7CHEN SINK 8 DISP ; CLOTHES DRVERS <br /> �, DISHWASHER � VENTILATION FAN � <br /> . LAUNDqY TRAY ; RANGE HO00 � <br /> CLOTHES WASHER � WqTER HEATER � <br /> l � � URINAL � WOOD STOVE � <br /> I DFINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) ' <br />� FLOOR DRAIN �_ <br /> ' FIREPLACE INSERT(WOOD BVRNING) i <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR. ETC.) � GAS RANGE —�" <br /> ' GAS PIPING � <br /> � EXHAUST FAN � <br /> � ' <br /> � � <br />� , ' <br /> � <br /> SUB TOTAL 5 � SUB TOTAL 5 ' <br /> PERMIT S � PERMIT $ , <br /> TOTAL FEE $ � TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONT SEiflACN REM SFTBnCK SIbE SETBRCK PL�N CIIEC NUMAER FEE RECEIPi NO <br /> usEzoNe LOiAPEA VACANi51tE FE��� VALUATION FEE <br /> nres r r+o ounniNa � <br /> NEIGNTLIMITRiION NO.OFOWELLING SIIEOfOLDGrtI � <br /> ❑NIIS <br /> i <br /> PWMOING i <br /> � <br /> �OUP��v ���SIOai[5 OCCUPANi�ORD �ASEMEN7 <br /> MECNRNICAL � <br /> IIVES I1 NO � <br /> FIREAURMREOD f�A504 ppD1110NAlPLANG��f.CK i <br /> PIpF.SPqINK1ERPE0'D qEAFON OtHER � <br /> SiA7E OIIILUING SURCIIAII[.E � <br /> TSPEOFf.ONST PI�NSRPPROJEOOV — <br /> CITY OF EVERETT rue�.ir,wonKs <br /> LOCAL SALES _ __ <br /> oniE TAX CODE IS 3105 TOTAL I <br />