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� � <br /> APPLICATION FOR CONSTRUCTION PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> f7 DEMQLITION f'1 COMBINATION i� BUILDING A�MECHANICAL 1� PLUMBING f 1 61GN <br /> PROJECT ADDRESS �. <br /> Sf'iN ER �v/�v TE L oT �` l) /-d� <br /> OYMER M�ILAppRF.SS CITY ZIP PNONE <br /> �cJ..z: ��oMEs �iia7 sT, RT 9 � v✓ouvirv✓�//E 98o7�L 2�+6 v8/ a es- <br /> IENANT MAILIIDORE55 C�T'! ZIP PHONE <br /> ��GHAFCT OR OESt6NEf1 MMl AOD�ESS CITY zIP PNONE <br /> QENE�M CONTOI1C70t1 MAI�AOOf1E5S CII� 211' PIIONE SfATE LICEHSF.� <br /> UF.S��N <NtiE.sTiY�rT �F�7Y �/j,J'7 S'T. RT �S�E u/OdDiNrii//E UcSi,�ROS.SvL <br /> MECIUNICAlCON1RnCTOl1 MAILADORE55 CITY 7.IC PIIONE ST�TELICFNSE� <br /> // /� / 1 / 1 <br /> MUMBINGCON7R�r,ipq M�ILAIX)RESS CIIY ZIP PHONE S7AiELICENSE� <br /> �� /r // // <br /> CONtMCT CFICE OF Wq1K <br /> HEATING SYSTEM: y�GAS fl ELECTRIC fl <br /> DESCRIBE VIORK I1N0 CqJARE FOOTAGE INVp�VED CONTACT FERSON AND PfqNE NO. � <br /> 5�/e NE STR J`� El/ /�/��FR 21S 2CX� /o - ff/O Afe7 <br /> ��et�wC� �4�, 20` Y /- EsBs aj�StE <br /> � I HEREBV CERTIFV THAT I HAVE READ ANO EXAMINED THIS <br /> rirorosFo use ov a�mar+a APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.AlL <br /> s�.� PROVISIONS OF LAWS AND ORDINANCES GOVEfiNINO THIS TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCiIIPTIONOFPqOPERTY�SNOWNBELOWOq�TT�CHTWOCOPIES) NOT. THE dRANTINO OF A PERMIT DpES NOT PRESUME TO GIVE <br /> ioT_�eiocK oF AUTHORITY TO VIOLATE OR CA';JEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REOULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEH OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION �S MAOE AND I COMPLV WITH THE STATE <br /> C�RCEL TNf I.D.NUMBEN CONTRACTORS LAW 1827 HCW AND 296200 N'AC. . <br /> � <br /> CONSiNUC710NlOAN LENDER.ADDRESS.TF.IEPNONE NUMBER x /�� �� S <br /> SION�tUPE D�TE <br /> CITV BUSiNESS LICENSE NO. <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> _3 WATERCLOSET(TOILET) � A/C—A/HNDL�UNIT3—H.P. � � <br /> � <br /> BATHTJB ; / FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> / SHOWER � UNIT HEATERS—B.T.U. M � <br /> / KITCHEN SINK 8 DISP i CLOTHES DRYERS � <br /> I DISHWASHEfi � � VENTILATION FAN � <br /> LAUNDRY TRAV ; ( RAN6E HOOD ; <br /> / CLOTHES WASHER � / WATER HEATER �— <br /> URINAL � WOOD STOVE ' <br /> DRINKINO FOUNTAIN i METAL FIREPLACE(WO00 BURNINO) � <br /> PLOOR DRAIN � FIREPLACE INSERT(WOOD BURNINO) � <br /> BACKFLOW PREVENTER9 � / pAS FIREPIACE ; <br /> SINK(SERVICE—BAR,F.TC.) i OAS RANOE � <br /> ' S GAS PIPINO ' <br /> � EXHAUST FAN � <br /> i i <br /> i � <br /> i i <br /> � � <br /> SUB TOTAL S � SUB TOTAI E � <br /> PERMIT S r PERMIT E � <br /> TOTALFEE S ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> fRONTSFTPACN RF.�RSF.TpM:K SIDESETB�CK �INN(:IIELKNUAIOER FEf �FLFIPTNO. <br /> �� �� S� ���v�' !✓O ` . <br /> usezor+ tornnen VACANf51TE FEES VALUATION FEE <br /> �— I ��9�j �s rir+o BUIIIIINC p Z — �vt' <br /> IIEIGNi LIMITATION � NO.OF�WELUNG SRE OF BLDGR � <br /> p VNIIS Zpvt �G LNA✓V 'f pUIMBING �n�i — <br /> 2�� 9O17 S.f Gaaq�� <br /> OCCUPAA'CY NO•:1i$IONE$ pCCUf'ANT lOAO BASEMENT /� + <br /> CfiOVP ' 1 � � MEGHnNIC�I _ J�/�� — <br /> •3 (�•� Z ry/Q f1YES fYNO —"—�Ly�---' <br /> fIREALARNqEO'D pFASON �00�110N�L1'I.�NC��F.CN � <br /> i <br /> i <br /> —�__ <br /> OIIIER i <br /> PIfIF.$Pf11NR1 EN RF.OD f1FAF(XJ <br /> _' ______"' "� <br /> StAI E fllllf OIHO SUOGI�ME <br /> rrrForr,oNST rinNsnrrnovener CITYOFEVERETT rumir.wnnKs G ; — <br /> �-/�) __ pn;e �JZ,G 9S TAX CODE AS 3 OS TOTAL �� �f� <br />