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APPLICATIOA FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAH STREET• EVERETT, WA 98201 •259-8810 <br /> f7 DEMOUTION fl COMBINATION I-1 BUILDING I�MECHANICAL �� PLUMBING f 1 SIGN <br /> PROJECT ADDRESS // ��� GU( Pc�C� � V� <br /> �� <br /> J�R✓� S IG YI I \U�ILI DURESS S�'J N�le �✓Q��C I / � D/ �U3 PNON[ i '��� ^ [�� <br /> vj 7 <br /> TENANT MAILADORESS CITY ZIP PIIONE <br /> ARCHITECiORDESIG ER MRIIADURESS GITV ZIP PMONE <br /> vl��v�;� (:�q�;�� /�s,�� is`� �E S�ql�-I� g�'r2�' 3G.7 39 '� r� <br /> ERRLCONTRAGTOR MAILADOPESS CIiY 11P PIION�� I�� S�TG�QC��� /�� <br /> �q/.�I-4 v � � / J <br /> MELHRNICRLCONTRACiOR MAl1.ADDRE55 GTV ZIP PIIONE STATELILENSE� <br /> 5�I �% <br /> PLUMBINGCONTPACTOR M�ILA�DPESS CItY 21P PIIONE STATELICENSk� <br /> 5 -`'I �`tQ_ <br /> CONTRIICTPRICEOFWOf1 � \ <br /> ��S , CX� HEATING SYSTEM: GAS rl �LECTRIC �l <br /> DESCRIBE WORK AND SOUARE POOTAGE INVOLVED CONTACT i'ERSON AN�PHONF N0. <br /> � �-rice C� �PG fiG ��'^9ct `+"�- <br /> �Cl p�� yPq er w� n 45 P 4/ �'�'+P✓1� � HEFEBY CERTIFV THAT I HAVE HEAD AND EXAMINED THIS <br /> APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> Prwrosq4�5�9B�I�DING �y�, /y WQqKSWILL BE COMPIIED WIT�H WHE HER SP CIF EDH EREPN OR <br /> � � <br /> LEG�LDESCRIPT OFPROPERTY�SHOWNBE .)WIXiRTTPCNTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oi aiocK oF 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 AUTHORI2ED BY THE <br /> G�(j �� � -U �� O D U(J OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> CX� APPUCATI� IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTN(ID.NUMBER CONTRACTO S LAW J�27 RCW AND,2 200 WAC. <br /> CONSTRIICTIONLO�NLEN�ER,�WRE55.TElEPHONENUMBEN X /� y�",.«�� �1���� <br /> SIG UFiE UATE � ����� <br /> CITY BUSINE55 LICENS[NO <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF Fl%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> r <br /> WATERCLOSET(TOILET) � A/C—A/FiNDLGUNITS—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORV(WASH BASIN) � HEAT PUMP o, O o� , <br /> SHOWER � UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK d DISP ; CLOTHES DRYERS � <br /> DISHWASHER � VENT�LATION FAN ' <br /> LAUNDRYTRAY ; RANGEHOOD � <br /> CLOTHES WASHER i WATER HEAT[R � <br /> UflINAL ' W007 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 /> i E%HAUSTFAN � <br /> � ' <br /> � ; <br /> � <br /> � ' <br /> SUB TOTAL S ' SUB TOTAL S ; <br /> PERMIT S � PERMIT S �� <br /> TOTALFEE S � TOTALFEE 3 ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSE(PACN RERRSF.TBACK SIDESET6�CK �IANCIIECKNUMAf:R fEE RF.CEIPTNO <br /> use zoNe tor�r+en vecaNr srte FE S VALUATION FEE <br /> � <br /> IIVES fl NO ��JIlDl9fi i <br /> HEIGIITLIMIiATION NO �DWEILING SIZEOFBLDGRI � <br /> i <br /> UNlfti PLUMOING � <br /> OCCUP�NCY NOO�SfORI�S OCCU�'pNTLOAO BASEMENi MECIIANICnL � <br /> GROUP � <br /> IIYES 11 NO � <br /> ADDI710Nn1 M�N G��f:CK � <br /> FIRE�LAqMREO[1 RE�SON <br /> i <br /> 0T11ER i <br /> FIRFSPRINKLERREO'D RF�SOH <br /> STNE AI➢IpING SURf.M�flfiE <br /> rvre or r,or+sr rinNs nrrnoven ov C�TY OF EVERETT runi ir,wones 1 <br /> �— <br /> LOCAL SALES <br /> DA7E TAX CODE IS 3105 7oTA� <br />