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^ � <br /> -APPLICATI4A FOR CONSTRUC7 .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STAEET• EVERETT, WA 98201 •259•8810 <br /> ❑ DEMOLITION � COMBINATION fTBUILDING MECHANICAL � PLUMBING fl SIGN <br />' PROJECT ADDRESS <br /> O Co�„�pn���.aC _ cJBa�-23 2:>'3- 3/S6 <br /> D�Ep MI11��DDRF.SS CI7Y ZIP PMONE <br /> I�cbe2T .D S�i���,Ra� 3003 ab�h sr tU�etJ7 9S'zol � S 6�• 3/ S`� <br /> IENANT MqL�DDRE55 GTY 21P P110NE — <br /> ARCHITFCTORO'E'SnIGNER MqL�DDRE55 LITV ZIP �MONE <br /> 8 LfJ�(1 v� <br /> I� GENERAICONTMCTOR MAILADDRE55 CIIV pIP PIIONE $iATELICENSE� <br /> MECH�NICRLCONTRqCTOR MAI�ADDRE55 CITV )IP PHpNE STqTEUCENSE� <br /> // <br /> PLIIMBINGCONTRACTOR MRIIA�OPE55 CIIY ZIP PHONE STATEUCENSE/ <br /> // <br /> CONTH�CT PAICE OF WO K <br /> Z HEATING SYSTEM: I�0 GAS rl ELECTRIC fl _ <br /> DESCRIBE WORK�N�SOUARE FOO AGE INVOLVEO CONTRCT PERSON AN�PNONE NO. <br /> I HEREBY CERTIFY 7HAT I HAVE READ AND E%AMINED THIS <br /> PROPOSED USE OF UILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � u��G� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF � <br /> LEGALDESCRIPTIONpFVRpPEqTY�SHONTlBELOWIXiATfACHTW0001`IES) WORK WILL BE COMPLIED WITFI WHETHER SPECIFIED HEREIN OR <br /> NOT. TI1E GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �orK-�7 N5�`!'-J8 eiocK 1�_oF F%i�e H4 D��v /�- AUTHOIiITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> 3y OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> v� � Q cOR�> >NU C PERFORMANCE OF CONSTFiUCTION.THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> W A S APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%1 D.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> S�/'� 4 - o l 3 �U 6_ aov3 AI/ `1 _ So o � ///��� <br /> CONSTRUC710N LOAN LEN�ER.�ODRESS.TELEPHONE NUMBER x�L p �+� 7-a e - 9� <br /> SIGNATURE DRTE <br /> CITY BUSINE55 UCENSE NO. <br /> PLUMBING MECHANICAL <br /> NO TYPE OF FlXTURE OR ITEM FEE NG. TYPE OP EOUIPMENT FEE <br /> WATERCLOSET(TOILE� /// � q/C—AMNDLGUNffS—H.P. � <br /> BATHTUB / ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) / � HEAT PUMP , <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES DRVERS � <br /> DISHWASHER � VENTILAT�ON FAN � <br /> � LAUNDRY TRAY ; RANGE HOOD <br /> CLOTHES WASHER � WATER HEATER , <br /> URINAL � WOOD STOVE � <br /> ORINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) ; <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> i <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ' GAS PIPING � <br /> i EXHAUSTFAN ' <br /> � <br /> � , <br /> � � ��� ' <br /> � , <br /> � , <br /> SUBTOTAL $ � SUBTOTAL $ � � a� �lJ-•'� <br /> PERMIT g , PERMIT $ , <br /> TOTAL EE $ � TOTALFEE $ � <br /> FOR OFFICE USE ONLY: /��U / C���� �(f;_;J <br /> � FHONTSFTPACK RE�fi5ET8�f.K SIDESETBRCK PI�NCIIECNNUMfIfR fEE ���� RECEIPiNO. <br /> 20 � 20� 5 � <br /> usezoNF��/ LOTAREA VACRMSITE FEES VALUATION FEE <br /> �\ � N�`(�3� t�. IIVES fiNO OUIIDINO � M <br /> NEIGNT UMITATION NO.OF DWELLING 512E O�ALOGRI J� � � <br /> Zq ' UN11S � ZSY3 SF Cnn�/< J' � <br /> -U PlUM01NG ��/_ i�� <br /> C! <br /> OCCUPANCY NO OtSi0RiE5 OCCUPANiIO�D BASEMSNI <br /> GROUP � � MGCIInNICAL /aO i �+v <br /> �'•3 Z N n ���Es U�r+o � <br /> FIqE AUR REOD RGSON �DO�110NA�PLAN CHFCK '1 i ;�O <br /> d � <br /> y – <br /> O7NER i <br /> FIRFSPR,�1(LEfiRE00 RFASON � <br /> �`j�ry srme nmioiNa sunr.unnce , 5D <br /> tmeorr,oNsr ainHsnrrnovonv CITYOFEVERETT rimi.ir,wonKs ���� <br /> _� ��" LOCAL SALES <br /> DATE S Z S TAX CODE IS 3105 70TAL �� <br /> 1 �— <br /> 1 . � /.1 ! � <br />