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� <br /> l-. <br /> APPLICATI4.�1 FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259 8810 <br /> fl DEMOLITION fl COMBINATION I-1 BUILDING f� MECHANICAL �l PLUMBING �l SIGN <br /> PROJECT ADDRESS <br /> '��03 �'��,�.�„vic� Drz. <br /> owr+E Maii on[ss <br /> � cm zir ri� Ne <br /> IENRN �J / ��7'773 <br /> MA .RpORE f.ITY 21P HO E <br /> A�CH TF.CT OR UESIGNEH M�II DRE55 IIP PHONF <br /> �� <br /> �z� /�S'� 2�J �`� i��.2 --/�� <br /> GE AL C Nl f.TOR • MRII DDRES$ QtV P PIIO - $iqTB tILGNSF.� <br /> J '/ `'] ���y <br /> MEC I�ONTRACTOR�J� MAI 0 R� r o ��� �! 71���p"pN�" �yT���"-/ ���JJ <br /> PLUM GC iRAf,T q M41 E55 Cltt ZIP PHONE STATELICENSE• <br /> CONTR�CTPRICEOFWORN �� � — <br /> HEATING SYSTEM: � GAS !� ELECTRIC f 1 <br /> DESCRIBE WORN AND$Ol1ARE F TAGE�NVOLVED GOYT�CI'PFq50N ANO PIIONE NO <br /> 1 HEREDY CERTIFY THAT I HAVE READ AND EXAMINED THIS � <br /> PROPOSEO USE oF em�oi APPLICATION AND KNOW 7HE SAME TO BE 7RUE ANU CORRECT ALI. <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPIIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�IUESCRIPTIONOFPROPERTV�SHOWNOELOWORARAGHTWOCOPIFS� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT _BLCCN or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ( PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOi„ZED BV THE <br /> 2/� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICAT�ON IS MADE AND I COMPLY WITH THE STATE <br /> PAR�EITA%ID.NUMBER %ONTRACTOR$I�W 1B:�CW AND 296200 WAC. - <br /> / 1 ^ <br /> CONSTRUCTIdi IOAN LENDER.AD�RE55.TFIEPHONE NUMBEB �� � � ' <br /> ��� � <br /> SIGNRTURE DATE <br /> LITY BUEIqE55 LICENS[NO. <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF flIRURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) � � A/C—A/HNDLGUNITS—H.P. � <br /> BATHTUB I ; FORCEDAIRSYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) / � HEAT PUMP , <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGF HOOD ' <br /> . � <br /> CLOTHES WASHER � WATER HEATER <br /> URINAL � WOOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) ; <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE <br /> ' �S GAS PIPING <br /> � EXHAUST FAN ; <br /> � ; <br /> SUB TOTA! S � SUB TOTAL $ � <br /> PERM!T 5 i PERMIT S i <br /> TOTALFEE $ � TOTALFEE S � <br /> FOR OFFICE USE ONLY: (n�� �� <br /> fRONiSFTP�CN RFARSETORLR SIpESETPACN PlANC11ECN•IU fICR �[f DS RECEIPTNO <br /> av �o �! .5�/ 70D — ��;" <br /> useior+� iornaen v�cnrasrte FEES VALUATION FEE � <br /> � – l ves n No ouiioiNc 9 C 1� ISZ Q�d �/� <br /> IIEIGIITIIMIUTION NOOFDWELLING SIZEOFBLD(:R1 � ' <br /> �n� VNIIG / �C�Ll�{S /�GQ�n�� {+1UM01NG // �+._ - <br /> / <br /> OCGUPANCY NO B SfORiES OGCUPANTIORD BnSEA�ENi _� i <br /> GROOP � M[CII�NICAL -f i�O <br /> U'I Z N II\ES KNO - (/ �� <br /> FlREALAnyneon RfA50N AOU�IION4LPlAHC��f:CK � _- <br /> n 1 —--T— <br /> rv� OrNER i <br /> FIRF.SPRI IERREOD RFnSp4 � <br /> �� SiAIE 11111lDING 511(if,lUfiGE ��O . <br /> 7YPEOFCONST PLANSr1PPnOVEpOY -- � <br /> CITYOFEVERETT ruenr.vmnns ,,90 �OC7 <br /> vT� LOCAL SALES -;— <br /> �—/•.� nn�E y 9S TAR CODE IS 3105 TorAL ;�rJ <br /> . <br />