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APPLICATIG�I �OR CONSTRIJCT�ON PERMIT <br /> CITY OF EVERETT•BUiLDING DIVISION �ie���� <br /> 3200 CEDAR STREET• EVERE'I"i,WA 98201 •259-8810 <br /> I-1 DEMOLITION j'a COMBINATION f1 BUILDING f-1 MECHANICAL `1 PLUMBING f 1 SIGN <br /> PAOJECT�}DDRESS/ � /�+ /� y� �/ ��� �'f `"" +�{�� <br /> /'�5� ! r i4 �f7 tJ v! YG G l�C�C 1 r (? , �( <br /> pMNEP MMLR�ORE55 / dTY Z�P {'NON[ <br /> ��� ` )7� � "� i��Z~A � l'i���i./ Uv� FvCr�e 1'� �76'3 3o3o7i3 <br /> TEN�Ni MNUDpRE55 dTT IIP FIIONE <br /> �9CNITLCTOROESIGNERO��M�IIADORE55 GIT' Zm PHONE <br /> ����� j•`•- <br /> GENEiiAL CONID�Gidi <br /> M�ILFODRESS CItY 21P �MONE $1AtGLILGNSE� <br /> �Se�� <br /> MECHANIC�I CANTHACiOP IMRII�UORE55 Gltt TIP PIIONE STRiF UCENCE <br /> l / <br /> �G ` ��n. Z�p pHONE $TATELIGENSE <br /> 1'LVMBINGCONTRACiIXi �41LAOORE55 <br /> � `� <br /> CONTMCTPRICEOF WORK /Ffl �— HEATING SYSTEM: I ' GAS f�l ELECTRIC f� <br /> l/ll <br /> DESCRIBE MlORIf AND SOU�RE FOOTnGE INVOLVED CONTRCT GERSON ANO PNONE N0. <br /> . i ji Q /r <br /> �� ✓ y I HEREOV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> J APPUCATION AND KNOW THE SAME TO OE TRUE AND CORFECT.ALL <br /> PROPOSEOUSEOFBUILDIN6 a� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ��Er��"�- WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�LOESGRII'TIDNOFPROPE isNownaE�owor�� - NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> Lot�BL�K Oj� p.a,oF � qa I �R�( 0/o G✓• AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br /> �el i�[5f/j� �w�%N N Lo%3 EL�+/ Gu,vT /Gvt A< PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHCRIZ�D BV THE <br /> OWNER OF THIS PROPERTY TO PEPFORM T WORK FOR WHICH <br /> � (N F1 oN L.R�r J� w t � J� � {�a APPLICATION IS �IAD 7AND I OMP , WITH THE STATE <br /> CONTRACTO 1B 7R AN 6.2 AC. <br /> PARGELTA%ID.NUMBER <br /> �71_ i�-ao3 �000 '' <br /> CONSTRUCTION IO�N IENDER,�DORE55,7ELEPNONE NUMBER pp7E <br /> I N�TURE <br /> CITY BUSME55 LICENSE <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FlI(TURE OR ITEM FEE NO. TYPE OF EQUIPMENT <br /> FEE <br /> ' WATERCLOSET�TOILET) A/C—NHNDLGUNITS—H.P. <br /> BATHTUB • FORCEDAIRSVSTEMS—B.T.U. M E.A. i <br /> � HEAT PUMP � <br /> LAVATORY(WASH BASIN) , <br /> SHOWER � UNITHEATERS—B.T.U. M <br /> KITCHF.N$INK 8 DISP i ' CLOTHES DRVERS ' <br /> i VENTILATION�AN � <br /> DISH WFSHER .x � � <br /> LAUNORY TRAV � RANGL HOOD � <br /> CLOTHES WASHER � WATER HEATER ' <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIREPLAGE(WOOD BURNING) � <br /> F�OOF DRA�N � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GASFIREPLACE <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> GAS PIPING � <br /> ; EXHAUSTFAN ' <br /> � <br /> � <br /> � <br /> � � <br /> � <br /> � <br /> � <br /> SUB TOTAL $ � SU8 TO7AL $ i <br /> PERIdIT $ � PERMIT S � <br /> TOTP.LFEE $ TOTALFEE S ' <br /> FOR OFFICE USE ONLY: neeemrr+o <br /> fRONT SFTPRCN REAR SFTBACK SIOE$EiBACN �UN/11- UMAf � <br /> rrn <br /> ipTpnE� V�GRNiSITE FEES VAWATION FEE <br /> US[ZONE � � <br /> nves ;lFu nminnu �SoJ /'1� I <br /> NEIGIIiLIMIlATION NOOFUWf.LLWG SIZE0�9lDGRl p���MOMG �1J� <br /> ❑NIiS ��I ST�� <br /> OGCUP�NCV NO O�SM�RS OCCU�AM lOAO B45BMEN7 MECIIRNICRL � �__ <br /> Cfl UI' � ^ �� I1 NO �� <br /> �-3 � AppI110NRL PLRN CNGCN �� <br /> FIREAIAPMREO� RFA50Y � <br /> qiHER � l <br /> ppF S��INNIER PEO�D REASON STR1E BURDINO SURCN�IICE 1�J�/ <br /> _�"_ <br /> tvreoFr,or+st v�nNsnrrnovepev CITYOFEVEREIi ruoi�r,wonns � r� <br /> N LOCAL SALES �J � <br /> onte � G SS TAX CODE IS 3105 TOTAL <br />