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APPLICATIOr� FQR CONSTRUCTIJN PERIIAIT <br />CITY OF EVERETT • BUILDING DIVISION �/ <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOUTION L"1 COMBINATION f7 BUILDING ft�MECHANICAL fl PLUMBING fl SIGN <br />PROJECT ADDRESS ` - � � <br />�lr-.. (� � r ! �. �C'. . i, �. !� ' i-C q I �J:�<^ j . ;.Il . � � <br />� <br />OWNEA ✓ M�ILAOOPES$ � Cltt ZiP PIIONE <br />Gb.. W. <br />p��{lap�•�l P� o� �33."�"�� 5 � e•az3oo 6..IIQvkeW�. 9eoo6-i3z3 _ <av6)r�43-4�0 <br />7ENANT MAllA0DRE55 CITV 21 PHONE <br />U ��Z �•SGC) .�/,,�1,�5-/_��rY���� � � Si .%1�.�.lOI!tt.�_ �5�11_,._(n�l'3-� �.Y <br />GENERALWNTRACTOR MAI�AOO�E55 CIN ZIP PHONE STAT[LICGNSE• <br />MECHANICALCONiHAC10R MNLADORE55 ��-f�R ua'ZOi ��TY Z�P PIIONE STATELICENSE� <br />. �' .��iC '{, Z1113 Co =: v_ i.% !; �. .i�,.-.J' �: t7,z�i?c/ri"��= ��/� `-'/i)� �-,,-,.,. � <br />�PWM9INOCONTRACTOR �Mp�LADURE55 Cltt ZIP PHONE STATELICENSE� <br />• .�'� U `� .: J . OJ <br />1 <br />�SCRIUE WORKAND S�l1Af1E FOOTAGE �NVOLVEO <br />2CP���c �-���r-- �oa v.�r,-� <br />�'� ; - �C'oo �= To F' �/�V I i <br />LOT <br />oF euaoir+a <br />BLOCK <br />HEATING SYSTF?M: LiGAS ❑ ELECTRIC ❑ <br />CONT�CT PERSON hN� F I IONE NO. <br />� i �V% :'.�L r;-r; i"yo6 77N-<' <br />I HEREBY �ERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATI('iN AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />/ PAOVISICIJS OF LAWS AND OR�INANCES GOVERNING THIS TYPE OF <br />( G✓n� �!•�//�L Bf��� WORK WILL BE COMPLIED N/1TH WHETHER SPECIFIED HEREIN OR <br />(ShIOWNBELOWORARACH7WOCOPIES) NOT. THE GRANTIIJG OF A PERMIT DOES NOT PRESUAfE TO GIVE <br />oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF �NY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTfiUCTION. THAT I AM AUTHOFiIZED BV THE <br />OWNER OF TH;S PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION �S MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />v��.7ce�Tax i.o. nurneen � <br /># <br />CONSTflUCTION LOAN LENOEN, ADORESS.7ElEP110NE NLIMOER <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />& DISP <br />LAUNDRY <br />CLOTHES <br />FLOOR DRAIN <br />BACKFLOW PI <br />SUB TOTAL S <br />PERMIT 5 <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />Ffi0NT5E18ALK PEAflSETOACN <br />USEZONE <br />HEIGHi UMITATION <br />OCCUPANCY NOAFSTI <br />GHOl1P <br />fIRL pLAFlM REO'D <br />FIRE SPRINNLER REO'D <br />LOTAREA <br />N0. OF OWELLING <br />UNITS <br />BY <br />FEE <br />CIN �USINE55 LICENSE NO. <br />NO. TYPE OF FI%TURE OR <br />A/C — A/HNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T. <br />HEAT PUMP <br />UNITHEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATFR HEATER <br />WOOD STOVE <br />METAL FIREf'LACE <br />FIREPIACE INSEF <br />GAS FIREPLACE <br />GAS RANGE <br />GASPIPING �p,� <br />�].,1 MBTU./N� <br />60 4vlCil�l.r <br />�C, mESTu/hr <br />SIDESEiDACK I P�ANCf1ECKfiUMOER <br />VACANT SITE 1'CC, <br />❑YES ❑ NO OIIILDINa <br />SIZE OF OLIX3R.1. <br />PLUM�:NG <br />BASEMENi MECIIANICAL <br />❑YES ❑ NO <br />AODITIONAL PLAN CHECN <br />OTHER <br />STRE �bIL�ING SURCHMGE <br />CITY OF EVERETT PueucwonKs <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />FEE <br />M E.A. <br />SU8 TOTAL S <br />PERMIT S <br />TOTAL FEE S <br />RECEIPT NO. <br />FEE <br />