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APPLICATIG�1 FOR CONSTRUCT�ON PERMIT I <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> fl DEMOLITION (1 COMBINATION f�@UILDING �l MECHANICAL � 1 PLUMBING f 1 SIGN <br /> PROJECT ADDRESS <br /> Z5 c� �� <br /> owr+ea Meiun(o�ness LL�j an zin <br /> � � T�(J�� IU �•-r r��orve <br /> TEyIiNT�� ��'� MrIILPDDRE 5 �1-#�� �� �� �IION� ��� ' �� <br /> / �.�� cin �] <br /> A rtEG-�R ^ MAIIADD ESS GITY �V� <br /> 7�� PNONE <br /> CEN[fa[ Ni1i�LTp11�//� MAI�LADf)f1E55 <br /> VV. K GtY ZIP PIIOIIE SiAiHLICFNSEr <br /> Jv / 1 vC`� <br /> MECNANICAL CONTRACTOR MAI�q�DRE55 ��n. <br /> ZIP t`/IO'.E STATE LIGENSE� <br /> PLUM8INGCONTRAC70R MAILADDRESS CITY <br /> z�P PHOYE STATE LIGENSE� <br /> � GONTRACTPRICEOFWpRK <br /> � �7T1� HEATING SYSTEM: ( 1 GAS fl ELECTRIC f 1 <br /> DESC�IBE WORK�NO SOUARE FOOTpGE INVOLVEO CONTpCT PF.q50N AND PI IONE NO. <br /> T� ^.c' r/a-�r)"C� <br /> . I HEREBY CERTIFY THAl' I HAVE READ AND EXAMINED THIS <br /> PPOI'OSEDU9E OF BIIIIUING APPLICATION AND KNON!THF SAME TO BE TRUE AND COFiAECT ALL <br /> PROVISIONS OF L4WS A!'r'il ORDINANCES GOVERNING THIS TYi�E OF <br /> , LEGALDESCRIP710NOiPRpPERTV(SHOWNBELOWORqTfpCHTWpCOPIES) �'�'ORK WILL BE COMFLIfD WITH WHETHER SPEGFIED HEREIN OR <br /> . NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> - LOT B��K o� 4UTHORITY TO VIOLATE OR CANCEI THE PROVISION OF ANY <br /> OTHER STATE OFi LOCAL LAW REGULATING CONSTRUCTION OFi THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWN[q OF THIS PROPEqTY TO PERFORM THE WORK FOR WNICH <br /> APPLICATIOtI IS MADE AND I COMPIY WITH THE STATE <br /> PAR�EL iAX ID.NUMBER Cf�NTR C70RS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRl1CTION 1 O�N LENOER,ADDPE55.TEIEPHONE NUMBER � <br /> x la' "�j's <br /> sicNar e oaTe <br /> GTY Bl15ME55 LICCNSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNOLGUNITS—H.P. � <br /> BATHTUA _ ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN� � HEAT PUMP <br /> SHOWER ' <br /> ' UNIT HEATEPS—B.T.U. M � <br /> KITCHEN SINK 6 DISP ; CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN , <br /> LAUNDRY TRAY � RANGE HOOD i <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE <br /> _ DRINKING FOVNTAIN i METAL FIREPLACE(WOOD BURNING) ' <br /> FLOOF DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTEFS � GAS FIREPLACE � <br /> SINK(SFRVICE—^AR, ETC.) � GAS RANGE ;— <br /> - _ ' GAS PIPING <br /> � EXHAUST FAN � <br /> . ' � <br /> i � <br /> i <br /> SUB TOTAL $ � SU8 TOTAI 5 ' <br /> � <br /> _ PERMIT $ � PERMIT 5 —T— <br /> TOTAL FEE $ � TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> fRONTSFiIiACk PEMSFT�ACK SI�ESETBACN PLANCIIFCNNIIMAC;R`/ - fEE / �� qEf.EIPTNO. <br /> L"7�'� )UC� <br /> Jv"�ll/ � /t1 <br /> usezoNe ioranen VRCRNTSItE FEES VAWATION FEE <br /> _ IIYES fiNO OUILDMf. <br /> 0 JIJ "� i � <br /> NE�GNTLIMITATION NO.OFUWELUNG SIZEOFOLIXi?I <br /> UNIfS � <br /> PWMOING � <br /> OCCUPANCY NO O[S�ORiES OCCUPANTLOAD BRSEMENT � <br /> f110UP MECIIRNIC�L � <br /> 2 IlYES � NO � <br /> fIAEAIARMREO'[1 RF.A50 ADD1710NPLPlANCHfCK � <br /> YES � Xff�i ' - <br /> OiNER i <br /> fI`R/F.SPPMNIERRE00 FEASON <br /> 7 �5 �1(ST� s.nie eunoir,c sunc��nnoe ' <br /> iraeorr,oNsr vtnNsnrr� vpouv CITYOFEVERETT rumir.wnnKs {�J <br /> � ,,/ �;n LOCAL SALES — �_ <br /> _ onie _ Z, - TAX CODE IS 3105 TO7AL � ' ;� <br />