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<br /> APPLICAT16r! FOR CON�TRUCT�ON PERMIT
<br /> CITY OF EVERETT•BUILDING DIVISION ^_ ' "d j� ,
<br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 � ' '
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<br /> 17 DEMOUTION �,/ >; �� " '
<br /> � cOM81NATION I-1 BUILDING fl MECHANICAL rl PLUMBING fl SIGN _ . ,�.�,"='
<br /> PROJECT ADDRESS U �( p t ' ' �sa^
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<br /> ONTIER MnILADORESS Cltt 21P pNONE �
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<br /> TEN�NT _/� 4RILAOORF.55 CIN 21P PIIONE
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<br /> RRCHITF.CTORDE9GNER MRII.AODRESS �I7Y 71P PNONE
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<br /> GENERALCONiR11CTOR MRIIADDRE55 C17Y plP PIIONE STATEIICENSE�
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<br /> MECHpNICAI CON7R �R MAIL PDDRESS � CITV ZI{` PIIONE STqTE IICENSE� }- /�
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<br /> PLUMBIN CONTRRf.•OP .�pAILAUDRE55 CIrV ZIP PHONE STA1ElICENSE•
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<br /> CONTRACT P IG OF VJQ11K
<br /> 1� � � �C�Q-�° HEATING SYSTEM: pJ�GAS I-1 ELECTRIC �l
<br /> ESCRIBE RN ND SOIIr1RE FOOT�GE IMVOLVED CONT� T PERSON ANO PIIONE N
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<br /> I HEREBY CERTIFY THAT I HAVE 9EAD AND EXAMINED THIS ��� '� .,44�;t+�;
<br /> APPLICATION AND KNOW THE SAME T^ AF'fRUE AND CORRECT.AL� '•�`�°,�',Y;;�-
<br /> PROi'OSED USE OF BUILDINQ 7 ,e�:`.,..- � ��
<br /> PROVISIONS OF LAWS AND ORDINANGES GOVERNING THIS TYPE OF " '•��^�• `li,
<br /> S�� Q F6�: Y' rS 1 e�iCQ WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR `,,�+�"`�,C,`+'_`
<br /> . LEGALD CRIPTIONOFPRppERTY OWNBELOW ATGCMiWOCOPIES) ',�;���''.7' ���"�
<br /> NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE - ,�!a.Y,;
<br /> ioT�e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY 'r ''^'
<br /> n� _,�j _ OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE _.; � ;'.:
<br /> Ol� GY / PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE ' �'�?��=��'��
<br /> OWNER OF THIS PROPERTY TO PERFORM THE WORh FOR WHICH >�� �
<br /> APPUCATION IS MADE AND I COMPLY WITH THE STATE �''��y„k�
<br /> PMCEI TAX 1 D.NUMBEf� CONTRACTORS LAW 1827 RCW AND 296.200 WAC. �S'����
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<br /> CONSTRUC'�'1N IOAN IENDEH.�DO{iE55.TELEPHONE NUMBER � �\ 3,; -� y x �/��H �'����s�� / -.j C.� � ��j ...i . .��;ill�:+
<br /> �O� Pir 'Sr'taie F �U /k ar q Q �(j C. SICNATU E Or1TE ���` -',!'tf•�„,i
<br /> 90(c �veo �a �f {nall (4.� Syc. �/5'0 L,�`' � �` /nN'�•/ri`�' L;cp.,s� "� o/6AD ;.,�_,;�;;� .
<br /> CITYBII ESSLICENSENO. -' "7�`' ;�`�
<br /> PLUMBING MECiiANICAL :;['„'':'.�;�'��' .
<br /> NO. TYPE OF Fl%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE � � - '" .
<br /> WATERCLOSET(TOILET) I ' PJC—A/HNDLGUNfTS—H.P. � �
<br /> BATHTUB / ; / FORCEDAIRSYSTEMS—B.T.U. M E.A. ; �
<br /> LAVATORY(WASH BASIN) � HEAT PUMP ,
<br /> � � SHOWER � UNIT HEATERS—B.T.U. M �
<br /> / KITCHEN SINK 6 DISP i i CLOTHES DRYERS 1 '
<br /> DISHWASHER � VENTILATION FAN �
<br /> f LAUNDRY TRAY ; RANGE HOOD � ' �
<br /> / CLOTHES WASHER - � WATER HEATER � i
<br /> URINAL � WOOD STOVE � I
<br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BUFNING) ; '
<br /> FLOOR DRAIN � FIREPLACE INSERT(WOOU BURNING) � �
<br /> BACKFLOW PREVENTERS � Z GAS FIREPLACE � ;
<br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE
<br /> ' GAS PIPING '
<br /> i E%HAUST FAN i
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<br /> SUB TOTAL S � ; SUB TOTAL $ �
<br /> FERMIT 5 ! � PERMIT $ �
<br /> �
<br /> TOTALFEE $ � TOTALFEE S '
<br /> FOR OFFICE USE ONLY: �F�B��
<br /> fR0f1T SFTMCK Rf:�tl SFTOACK SIUE SETOACN PtAN CIIECN NUMOEfi FEE L,.(J AEf.EIPT NO
<br /> r5-ZT3' r�' �"' �i wK T.Sa-/s' ! ��/ �
<br /> usezoNe IOi�REF p VACANiSIIF. FEES VALUATION FEE
<br /> �� ���9(> J�'Tf5 I i NO p�ILDING 2 ?—
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<br /> IIEIGMT LIMI7ATION NO OF UWELLING 512E O�AIOG/II �
<br /> � � uNns � 30S¢ S,F. Gvi�d4t I(�S�
<br /> 5 S F. qaqGE r�uMnwc
<br /> OCCUP�NCY Nb OfStOWES OCCUPANiLOAD BASEMENT � MECIIRNIC�L 8� �
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<br /> f1YES I{YNO
<br /> FIRE ALMA�REOD iif-ASON ��DIIION41.PIAN CIIf.CK �2 �X
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<br /> fIRF.SPRINNIERRE00 RFASON
<br /> Yrs STAIEOUIIDINO511fiC114RGE — _i /��
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<br /> tvre or r.oNsr vim�sarrnoven or CITY OF EVERETT runi ic won�s
<br /> LOCALSALES — ?D-t—
<br /> —/J oaiE � ZI (o TAX CODE�S 3105 iOTAL I��
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