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r., ,-� <br /> APPLICATiON FOR CONSTRUCTION PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> f� DEMOLITION �� COMBINATION fl BUILDING f� MECHANICAL <br /> PROJECTADDRESS PLUMBING fl SIGN <br /> 3$�2S cvl�' y <br /> ONTIER /+ M�I!ApppE55 <br /> ��I�A� G 12 a u un zm m�oN� <br /> una.n � nV Q°.r �'�'3D �vtR 93N a 1 � 5 � S /67 <br /> � CITY ZIP <br /> q�, t b s u v� <br /> ECTURDE9GNER MNLADURESS <br /> ��ry ZIP 1 HONE <br /> GEry/�E fta��OHiRACTOR MARppDBE55 <br /> p��P � �I' CIIY IIP FnONE <br /> � 7/ 3 � S y ,L� /) StA1ElICGNSE• <br /> MECN 1Xf p� MAII ADDRE55 � �� ��� // � �`���(-J 90- !t 9 � �U �'�W� � v K o— <br /> ZIP P110NE SiA LICENSE• <br /> PLIII.IBINGCONTRACTpR M41LA�ORESS <br /> ��TM Z�P P��ONE <br /> STAiE IICENSE� <br /> . CONTqACT PqICE OP WpRg — <br /> HEATING SYSTEM: f �GAS r� ELECTRlC fl <br /> DEiCRIBE WORK AND SOUARE fOpTpGE INVOLVED <br /> CONTqCT PERSON ANO PIIONF.NO. <br /> 7� — 2 F/�� .� s�� — <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED iHIS <br /> nnoroseouxeoc avaoiNa APPLICA710N AND NNOW THE SAME TO BE TRUE AND CORREC7 ALL <br /> �f�'/L FI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEG�LOESGRIPTIONOFPqOPEPTY�SNOWNBELOWORATTpCNTYOCOPIES� �'ORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> . �oT NOT. THE GRANTING OF A PERMIT DOES NGT PRESUME TO GIVE <br /> e;ocK or AU7HOFITY TO VIOLAiE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR IOCAL LI'JJ REGULATING CONSTRUCTION OR TfiE <br /> PERFORMANCE OF CONSTAUCTION.THAT I AM AUTHOR2ED BY THE <br /> OWNER Of THIS PROPERTY TO PERFORM THE WORK FOp WHICH <br /> APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br /> PARCELTA%I.U.NUMBER CONTRACTORSLAW1B27 qWAND296200WAC. <br /> CONSTPUGTON LO�N ICNDER,�pDRESS.T[�EVIIONE NUMBER � / <br /> x ' i .Y `�6 <br /> SIG <br /> D/ E <br /> CITY BUSINE55 LICENS[N0. <br /> PLUMBING <br /> N�• TYPE OF F1XTUqE OR I7EM MECHANICAL <br /> FEE N0. TVpE OF EQUIPMENT <br /> WATER CLOSET(TOILET) --- FEE <br /> ' A/C—A/HNDLGUNITS—H.P. —�— <br /> BATHTUB , <br /> LAVATORY(WASHBASIN) ' FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> SHOWER ' HEAT PUMP ' <br /> i � <br /> KITCHEN SINK 8 DISP UNIT HEATERS--B.T.U. M , <br /> DISHWASHER � ' CLOTHES ORYERS , <br /> LAUNDRY TRAY � VENTILATION F.�.N � <br /> i <br /> i RANGEHOOD –�— <br /> CLOTHES WqSHER ; <br /> URINAL ' WATER HEATEF <br /> ORINKING FOUNTAIN � WCOD STOVE , <br /> FLOOR DRAIN ' METAL FIREPLACE(WOOD BURNING) � <br /> ' FIREPLACE INSERT(WOOD BURNING) , <br /> BACHFLOW PREVEN r <br /> SINK(SERVICE eqq, �,j <br /> � GAS FIREPLACE , <br /> GAS RANGE <br /> GAS PIPING � <br /> � EXHAUSTFAN � <br /> _ , � <br /> � <br /> � <br /> ' �— <br /> SUB TOTAL $ � ' <br /> $ ' SUB TOTAL S � <br /> PERMIT i PERMIT <br /> TOTAL FEE $ i — $ ' <br /> TOTAL FEE $ —�— <br /> FOR OFFICE USE ONLY: <br /> FRONTSETPqCN RE�R SETBRCN SI�ESET�ACN <br /> PLqNCHECKNUUOER fE@ RECFIPiNO. <br /> USE 20NE IDT qRER VALAN7 SIiE <br /> FEES VALUATION FEE <br /> tiYES fi k0 <br /> NEIGHT L�MITATION OUIIOMG � <br /> UNIf�OWELLING SIZEOF9lOG/TI � <br /> 1'LI/MpIN6 � <br /> i <br /> OCCUPANCY rro ovsinnics OCCUPANiLORO BASEMENi — � <br /> GPOUP MEC11n1JILAl i <br /> IlYES fI NO � <br /> P�REALAl1MREOl1 R[q50N Ap01110NALPLr1NCMfCK <br /> i <br /> fIqESPRINRIEAPEOD q[qcpy <br /> O711ER —� <br /> STAiE OOIIOiNO SUqCHFqGE i <br /> IYFE Of f.ONST PLI1N$APppOVED�V <br /> CITY OF EVERETT ruenr,wones -- <br /> LOCALSALES —_ <br /> unTe TAX CODE IS 3105 TO7AL j <br />