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APPLICATI� N FOR CONSTRUC'_ .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEGAR STREET• EVERET'f, Wq ggpp� .p59_8810 <br /> Cl DEMOLITION (l COMBINATION f� BUILDING <br /> PHOJECTADORESS MECHANICAL r� pLUMBING n SIGN <br /> �iS A� � <br /> OWNER MRIUDpRE55 <br /> NCIQiY' /, /fij� / /I cm na <br /> � �n'i�� 7SSI'J ( C'[�L� AUF PHDNE <br /> MAILADDRE55 'C''f'��- n7 5�'7�2 7 � 7��l <br /> LITY T.IP PHONE • <br /> ARCNIT[CTORpE51GNER MAILAD�RE55 <br /> C'TM Z1P VHONE <br /> GENEflRLCONTqACiOq MqLADDRE55 <br /> CITY 2�P PHUNE <br /> STATE LI�ENSE� <br /> MECH�NILALCONTR4CTOR M�ILADIX1E55 <br /> �� GTM ZIP PIIDI:E <br /> STA7E LI�ENSE� <br /> "- '- GTOR M4ILAODRE55 <br /> C�tt LP PNONE <br /> STATE IICENSE� <br /> GONTp�GT VqILEpE yypqg <br /> �-CJ <br /> HEATING SYSTEM: GAS f�ELECTRIC f� <br /> DESCRIBE WORN AND SOUARE Fpp7�GE INVOLVEU <br /> � � �� c/L ��N`^J � CONTACTP[qSONANppHONENO. <br /> /1i..0 t ZSz-.��� <br /> iF /GD Cb0 �j qT iA5 FU2Ui4!'E. <br /> 1 Sd ��/ �WT I HEREBY t;ERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PADPO�ED USE OF BUILOIN6 APPUCATION AND KNOW THE SAME TO BE TRUE AND CORREC7 qLL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE pF <br /> �EGA�DE CRmTONOFPROPERTY�SHOWNeELOWOR�77,�q7�yOCOP1E5� H'ORK WILL BE COMPLIED WITH WHETHER SPEC�FIED HEREIN OR <br /> � ior Bi�K � NOT. THE GRANTING OF A PERMIT DOES NOT PpESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LpCAL LAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUC710N.THAT I qM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> PARCEITN(ID.NOM�ER APPLICATION IS MADE AND I COMPLY WI7H THE STATE <br /> CONTRACiORS LAW iB27 RCW qND 296200 WqC. <br /> CANSTRUCiiON�O�N LENOEN,ADDRE55,TELEPHONE NUMBER X/ / /����� <br /> Sl�i! .�/� /96 <br /> sicr�(rur� <br /> o�re <br /> PLUMBING CITV BUSINE55 LICENSE NO. <br /> NO. 7YPE OF FlXTUpE OR ITEM MECNANICAL <br /> WATER CLOSET(TOILET) �E N�' T�'�E OF EpUIPMENT <br /> , FEE <br /> BATH7U8 �✓C—AMNDLGUNR�—H,_p _ —�— <br /> � <br /> LAVATORY(WASH BASIN) ' FORCED AIR SYSTE'dS—B.L_ ��_M E q �--'-- <br /> SHOWER ' HEAT PUMP � <br /> ' UN17 HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP , <br /> DISHWASHER ' CLO'HES DRYERS , <br />' LAUNDRY TRAY � VENTILATION FAN � <br />, CL07HES WASHEq ' RANGE HOOD � — <br /> URINAL ' WATER HEATER � <br /> � � <br /> DRINKING FOUNTAIN WOOD STOVE � <br />� FLOOR DRAIN ' METAL FIREPLACE(WOOD BURNING) � <br /> ' FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PpEVENTERS , r <br /> SINK(SERVICE—BAR.ETC.) ' GAS FIREPLACE � <br /> GASRANGE <br />, GAS PIPING � <br /> � EXHAUSTFAN <br /> � �:_ <br /> � � <br /> i <br /> � <br /> i � <br /> SUB TOTAL $ � � <br /> PERMiT $ � SUB TOTAL y �y— <br /> i i <br /> 70TALFEE S , PERMIT g � —� <br /> FOR OFFICE USE ONLY: Tora�FEE a � <br /> FAONTSETBACR REAq SETBACK <br /> SIDE SET6A�N PUN CIIFCK NUMOf <br /> �/�/� fEE RECEIPT ND. <br /> USEZONE IOTFREA V�CANi51�E <br /> FEES VALUATION FEE <br /> nres r tio --'--- <br /> IIEIGIIf UMIT�f10N NO OF UWELLING BUIl01Nfi � <br /> UNIf$ SIZEOF9LDCRJ � <br /> PLUMpING � <br /> OCCUPFNCY NOO�S70AiE5 OCLUPANT�ORO � <br /> GROUP BASEAIENi _ ' <br /> M[CIUNICqL � <br /> 11YE5 fl NO � <br /> FIREAUqMREOp R[ASON �DDIIIONALPLpNCNf:CK � <br /> i <br /> GIRESPqINKLERREO'D REFSON Oi11E(i � <br /> i <br /> STN[DOIIDINC SURC11pR0E � <br /> TYPE06f.ON5T PLr1NSAPPpOVEDBY � <br /> CITY OF EVERETT rueur,woaKs —�;— <br /> LOCAL SALES ; <br /> oarE TAX CODE IS 3105 TOTAL � - •. <br />