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APPLIGATIt�I�I FOR I;ONSTRUC110N PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET• G-VERETT, WA 98201 •259•8810 <br /> I-7 DEMOUTION �1 COMBiNATION BUILDIIVG rl MECHANICAL i � PLUMBING �I SIGN <br /> PROJECT ADDRESS � �./,' / �D` � � � ✓� <br /> �7 �y <br /> OIYYER MAILAD�R�ES,S/�t y� Cltt 21P PNONE <br /> W�' .-1�!�1..� �i�/1✓L- K���'L{ <br /> 1 UN/T� �(�p '^'/��p�AAILADORESS�([,// //J�� / ��{GiY p// IIP �,jp�y v�HONE /� oI/ <br /> ARpL�/'l'f.��GN�'VT1 'LLS^D��71 W/O�/ / /" - (..(fe�}-�P�• � /OW/E �V� ��07 � <br /> GENERRLCON7RACTOR MAILAO�RESS CITv pIP PNONE STATEUCENSE� <br /> MECNANICAL CONTRACTOR MAIL�DOAE55 CITV ZIP PIIONE STATE LICENSE� <br /> PLUMBINCaCONTRACTOR NAI�AUDRESS CIiV IIP PHONE STATELICENSE� <br /> � CONTR�CT PRICE OF WIXiK <br /> S�� HEATING SYSTEM: I� GAS ❑ ELECTRIC ❑ <br /> OESCRIBE WORK AND SOUARE FOOTAGE INVOLVED [ONTRCT 1'ERSON RND PMONE N0. <br /> c�� � F/�� l.t/f�'(�L P 7G�� D /�'l.�E <br /> -� �O O4 , I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF BUILDIN6 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONCi OF LAW3 AND ORDINANCES GOVERNING THIS TYPE OF <br /> � WORK WILL BE COMP��D WITH WHETHER SPECIFIED HEREIN OR <br /> , LEGAl0E5CRIPTIONOFPPOP[RTV(SIIOWNBELOWOqAtiNCHTWOCOPIES) NOT. THE GRANTING OF A FERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCK or AUTHORITY TO VIUTATE OR CANCEL THE PROVISION OF ANY <br /> � OTHER STATE OR LOCAL LAN'PEGULATING CONSTRUCTION OR THE <br /> PERFORMANCc OF CONSTRUCTION.THAT I AM AUTHORRED BY THE <br /> OWNEF OF TH�S PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APP TION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%I.D.NUMBER C TR11 TO S LAW 27 R �'V AND 296.2 C� <br /> CONSTRUCTION LO�N IENDER,pODPESS.TELEPHONE NUMOER X <br /> 51 NAIUR DATE <br /> CITY BUSINESS LICENSE 1�0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF FIXTURE OR ITEM FEE <br /> WATERCLOSET(TOILEn � A/C-A/HNDL�UNITS-H.P. � <br /> BATHTUB ; FORCED AIR S1'STEMS-B.T.U. M E.A. ; <br /> _ IAVATORY(WASH BASIN) i HEAT PUMP , <br /> SHOWER � UNITHEATERS-B.T.U. M � <br /> KITCHEN SINN 8 DISP ; CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRYTRAY � RANGEHOOD ' <br /> � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL � WOOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIREPLACE(1VOOD BURNING) i <br /> FLOOR ORAIN � FIREPLACE INSERT(1VOOD BURNING) �- <br /> BACKFLOW PREVENTERS ' GAS FIFtEPLACE ' <br /> SINK(SERVICE-BAR,ETC.) � GAS 9ANGE � <br /> ' GAS?IPING ' <br /> i EXHFUSTFAN i <br /> � � <br /> � � <br /> � <br /> � i <br /> SUBTOTAL $ � SUBTOTAL S ; <br /> PERMIT 5 i PERMIT $ � <br /> TOTALFEE S � TOTALFEE 5 � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETOACN REARSFTOACK SIDESETBRCK p�/NCHECaJµIA�Of[i fEE RECEIPTNO. <br /> �//J(f <br /> <J�/ <br /> USE lONE IOTARC.I V�CANi SITE FEES VALUATION FEE <br /> IlYES ❑ NO OUILDING 5� ^ � <br /> ilE1GMTLIMItAT10N NO.OFDWEWNG SIZEOFOLOGRI. � <br /> UNITS P�UMOING i <br /> OCGUPRNCY h0 O�Si0PIE5 OCCUPANTLOAO BASEMENT MEGHRNICAL � <br /> GROUP <br /> ❑YES [l NO � <br /> � ♦ <br /> FIPEPL�RMREO'D REASON AODI110NALPLANCM9CK � <br /> � <br /> OTIIER � <br /> FlRE SPRINNLER REO'D REASON <br /> STATE BUILDINO SURCNARG[ � <br /> i <br /> TYFEOFCONST PNNSMPROVGOBV C�TYOFEVERETT PUBLICIYORKS � <br /> LOCAL SALES ; <br /> oq,E TAX CODE IS 3105 7oTAL ; <br />