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APPLICATIt�r�! FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> I-1 DEMOUTION (l COMBINATION fl BUILDING f� MECHANICAL f� pLUMBING �l SIGN <br /> � PROJECT ADDRESS <br /> `.=6� f �Ul�o�n � ���se`� 98�0 3`c�5-��55 <br /> �j OVMER M�IL�ODRF.SS Citt ZIP PMON[ <br /> TE�SSoNI�c��e���la\�555 v� �s ��cx1l��'� S,�ol�oP,n� l tW�'�PQBa°�I 3��-5�55 <br /> ARCHITECT OR�ESIGNER MAIL RDDRE55 GITV IIP PHONE <br /> N�a <br /> \IG�, LONiRACTOR MRIIannRE55 qfY ZIP PNONE 51r1TELICENSE• <br /> n• <br /> G`Cr�NC� � . .. . ... <br /> MECNl1NICALCONTRRCTOR � MAILAqDRE55 QTY � ZIP PIIpNE STAIELIL[NSE• <br /> PIUMBINGCONTPACTOR MRIIADDRE55 CITY IIP PHONE STATELICENSE� <br /> CONTRACT PRICE OF WORK p <br /> d c� D ��O HEATING SYSTEM: [l GAS ELECTRIC fl <br /> DESCRIBE WOl1K ANO SOUARE FOOT�GE INVOLVED CONTACT FERSON ANO PIIONE NO <br /> �'�lcc�ct� eY.�S'�i�n� i�},0.C4U� 'to eau ,es7UTA2_� 6TLJt GC: <br /> w � � <br /> A 38 �-�� - ,!' i._-�,,, <br /> -F I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSE OF BUIL � APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT ALL <br /> U A¢t h{JC.E C�.IyE,ULl�'�� PflOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> iec oes aWttp,��v P TV�SHOWNBELOWORATfAGHTWpLpPIES) WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �aS s-!��tE�� 1 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> wT � 1 aiocK._l_oF� � •� , 'fa AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> }�'�oft,� -�t, +I�o {�{�Q(Qp� � V PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOHIZED BV THE <br /> OWNER OF THIS PRO EFlTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS AqE AND I COMPLY WITH THE STATE <br /> r�eEl T�z0.0. M9E^}�Q�04N�W V� SPO{^�S'I't��a of' /,, CON7 A TOR�LA 18.27 RCW AND 2962001NAC. <br /> TU, T� <br /> CONSTHUCTION LOAN LENDER.�UDFESS.TEIEPNONE Nl)MBER J(�� � �� _( <br /> S1 TUPE OATE <br /> / <br /> (�CQ ���5 CITYBUSINESSLICENSENO <br /> PLUMBINO MECNANICAL <br /> NO. TVPE OF FlXTURE OR ITEM FEE NO. TYPE OP E�UIPMENT FEE <br /> / WATERCLOSET(TOILET) � A/C—AIHNDLGUNITS—H.P. � <br /> / BATHTUB ' FORCEDAIRSYSTEMS—B.T.U. M E.A. ' <br /> � � <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � NIT HEATERS—B.T.U. M � <br /> / KITCHEN SINK 8 DISP ; / LOTNES DRYERS ' <br /> � DISHWASHER � VENTILATION FAN � <br /> LAUNURYTRAY ; / ANGEHOOD ' <br /> � <br /> CLOTHES WASHER � ATER HEATER � <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) ; <br /> _ FLOOR DRAiN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS � GAS FIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ' GAS PIPING <br /> � E%HAUST FAN � <br /> � , <br /> SUB TOTAL S ; SUB TOTAL $ ; <br /> PERMIT $ PERMIT S � <br /> TOTALFEE S ' TOTALFEE S � <br /> FOR UFFICE USE ONLY: Cj/J,�.yq� ��--J�'% �J� (,,J <br /> FRONT SETPRCN � PE .T CK S�DE SETBACN PUN CIIEf.N��Efi FEF/��/n REC[IPT NO <br /> l/ <br /> use zor+e /� LOiA{iE� V�^,ANf SIiE FEES VALUATION FEE <br /> ���� fIYES r ruo ow;owc � �--� ( ll �� 7 '� � <br /> ✓ ��..; <br /> HEIGIIT LIMIiATION NO OF UwELLING 512E OF BLDGRI � <br /> Z UNIiS /� PllIM01NG � <br /> {�07 S�: _ � <br /> OCCUPANCY NO O�SIOa�ES OCCUPANTLO�D BAFEMENT � <br /> GRWP / MECMnNILaI � <br /> I f7vE5 �1 NO — � <br /> FIRE AIMM REOD R[�SOY AOOIIIONAI PIAN CHF.CN <br /> OTIIER i <br /> FIRF.SPRINNLERREOD PE�SOY <br /> i <br /> STAIE UI1IlDRlG SURr�IMGE — i i <br /> rraeovcoNST �inNsnvrn veoov CITYOFEVERETT ruour,wonrs <br /> � ` � � LOCAL SALES -�— <br /> '�v oare (y�S TAX CODE IS 3105 T07AL <br />