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APPLICATIO.� FOR CONSTRUCT.JN PERMIT� <br /> CITY QF EVERETT•BUILDING DIVISION <br /> 3200 CEDAP.STREET• EVERETT, WA 98201 •259-8810 <br /> f1 DEMOLITION f l COMBINATICN �l BUILDING MECHANtCAL �l PLUMBING f l SIGN <br /> PROJECT ADDRESS JJ <br /> —(,SO C � L � YL ___ <br /> OWNER MnRADDRE55 CITv IIP PHON[ <br /> 1��iL �c TC�l7ilC ' �'OliaX 1�(c8 iCX� STc /r�+/S `/f�'/�b` .3a3 U ?/ 5 <br /> TENANT MmLA0DRE55 CITY IIP CNONE <br /> APGNITEGTORDESiGNER MMIAD�HE55 GITY 71P PMONF <br /> GENEPRLfANTRRCidi MRI�ADURESS GtV ZiP �HON[ 51ATElICCHSE• <br /> MECHRNIC/.LGOYTRAGTOR MAILFOORE55 dTY DP P110NE��,G 51ATELiCF.NSE� <br /> �„a��s i�(r� .+„�� � � r�,a �ox >s�� � OGin oJi+- 9Rs�o -a,>�� �y.�dy.�y-/l�;s:�a�Er�s�� <br /> %UMBINGGONTR/�CTOR M4ILAODRESS C Y � 21P PMONE STATEIICENSC� <br /> CONTR�CT PRICf OF=ORKn HEATING SYSTEM: D4 GAS fSk'ELECTRIC I-1_ <br /> 5��.5' P"�vS '— — <br /> DESCHIBE WORN�ND SOUnRE FOOUGE INVOLVED CONTPC7 P[RSON ANU i'HONE NO <br /> -� r ���o- u 3 <br /> ,{�iGE' T%L.Jj 3U3 6 <br /> I HEREBY CERTIFV THAT I HAVE READ AN� EXAMINED THIS <br /> APPIICAT�ON AND KNOW THE SAME 70 BE TRVE AND CORRECT AlL <br /> raoroseo use ov euaowo PROVISIONS OF LAWS AND ORDMANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED IiEREIN OR <br /> IEGALDESGN�PTIONCFVROPEPTYISMOWNBELOWONATT�CH7WOCOPIE51 NOT. THE GRAN7ING OF A PERMIT POES NOT PRESUME TO GIVE <br /> �or e�ocK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTHUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF TI-IIS PROPERTY 70 PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> PMCEL TA%ID.NUMBER � s <br /> F�-� <br /> CONSTRUGTIOP�t Q�N IENMR.�DDRESS.TEtEPNONE NUMAF.R X <br /> � SIGN IURE OATE <br /> c� z�' 7s� <br /> cin euswess uc�Ns�r+o. <br /> P��.�B�H� MECRANICAL __ <br />� NO. TYPE OF FlI(TUHE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATE(iCLOSET(TOIIET) � A/C-AMNDLGUNITS-H.P. ' <br /> BATHTUB � FORCED AIR SYSTEMS-B.T.U. M E.A. i_ <br /> LAVATORY(WASH BASIN) � HEAT PUMP ' <br /> SHOWER � UNITHEATERS-B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRVERS � <br /> IDISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY � RANCaE HOOD � <br />� CLOTHES WASHER � WATER HEATER ' <br /> URINAL ' WOOD�TOV[ � <br />� DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN FIREPLACE INSERT(WOOD BURNING) ' _ <br /> i <br /> BACKFLOW PREVENTERS � GAS FIREPLACE ' i <br /> SINK(SERVICE-BAR,El'C.) � � GAS RANGE ' <br /> � GAS PIPING � <br /> ; E%HAUST FAN ' <br /> � <br /> � <br /> � � <br /> � <br /> � <br /> � - <br /> SUB TOTP,L $ � SUB TOTAL $ _ <br /> PERMIT $ i PERMIT 3 / ) � <br /> TOTAL FEE S TOTAL FEE S ' � <br /> FOR OFFICE USE ONLY: <br /> n�crmiNo <br /> FRONTSETPRCR �E��SFIDRCK SIpESETORLN PII.NGIIECN�IM�� fEf <br /> FEES VALUATIUN FEE <br /> US[ZONE 1 OI AnE� WCRNT 511[ � <br /> tIYES f'� NO pUIIOMG � _ <br /> i <br /> i <br /> NEIGN7UMIi�TION NOOFDWELUNG 512[O�ALU(irtl � <br /> UNIIS 1'LIIMOING � <br /> i <br /> OCCUP�NGV NO Of SiDn�C< p�CUPANi lOAO BASEMENT V[CIInNIL/.l I <br /> CI10UP � <br /> I1VF.5 fl NO � <br /> � ADDIIiONM.PL�N GILCK � <br /> FlREALARMRGOLI RFR50Y � <br /> i <br /> qiHEP � <br /> fIRESPRINNI[RREOD �FASON � <br /> STRI6IIWLOMG SUf1CHRRGE � <br /> �_ <br /> i <br /> tvreorr.or+si vinNsnrrnoveoer CITVOFEVERETT run��r,vmnKs , ' <br /> LOCAL SALES j <br /> onrt TAX CODE IS 3105 TOTAL — <br /> �w■ <br />