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APPLICATIOrI FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259•8810 <br /> fl DEMOLITION fl COMBINATION f-1 BUILDING f�l MECHANICAL PLUMBING f l SIGN <br /> PROJECT ADDRESS 2 �/ G � <br /> OWNE�/'1 1/ .i V�/ M�IL�SS ll'T,L / �� /I V� Gltt 21P � PIIONE ���^0��� —_ _ <br /> TENRNi/ � /' MAILADDRF.55 � ���� ��/D <br /> f,ITY IIP PNONE <br /> ! <br /> ARGHR[CT OR DESIGNER MAII.AD�RE55 GITV 21P PNONE <br /> �� CIIY 71P PIIOYE $IDiE IIC[NSE• <br /> GEN[f1�LCONiMGiOR NAILADOR[55 <br /> MECHRNICALCONTR�CTOR M41L�ODRE55 CITV 71P PIIONE SiATE�ICF.NSE• <br /> PLUMBINGCONiRPGTO MAILADUFES CI7Y 21P PHONE STAIEUGENSE• <br /> �fK2,L 1,1�655 <br /> GONTRRCTPRICEOF WORK HEATING SYSTEM: I l GAS �l ELECTRIC fl <br /> OESCRI9E RK AN SOUARE FO,O11TAG INVOLVED p CONTPCT PFPSON ANO PNONE NO. <br /> �W �.C� <br /> I HEREBY CERTIFY THHT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TfiUE AND CORRECT ALL <br /> PROF'OSED USE OF B111L01NG ��n� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> � WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALOESCRIPTIIXlOFPROPERTYISHOWNBELOWORATTpCHTWOCOPIES) NOT. THE GRAN7ING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior e�ocK aF 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 AUTHORRED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORht THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS L W �B R ND 296200 WAC. <br /> PARCELTA%ID.NUNBER <br /> � � <br /> CONSTRUCTIONIO�NLENOER.ADDRESS.TEIEPNONENUMBER J( DnTE <br /> SIGNATURE <br /> CIN 6VSINE55 LICENSC NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TVPE OF EGUIPMENT FEE <br /> WATER CLOSET(TOILET) <br /> � A/C—A/HNDLGUNRS—H.P. ' <br /> BATHTUB ' ;�' FORCED AIR SYSTEMS—B.T.U. M E.A. i <br /> , HEAT PUMP ' <br /> LAVATORY(WASH BASIN) , <br /> SHOWFR � UNITHEATERS—B.T.U. M <br /> KITCHEN SINK&DISP CLOTHES ORYERS ' <br /> i <br /> � VENTILATION FAN ' <br /> DISHW�SHER � RANGE HOOD � <br /> LAUNDRYTRAY � <br /> CLOTHES WASHER � WATER HEATER ' <br /> URINAL � <br /> WOOD STOVE � <br /> � <br /> DRINKIIJG 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 /> � GAS PIPING � <br /> � <br /> EXHAUSTFAN ' <br /> � � <br /> � � <br /> � ' <br /> � � <br /> � <br /> SUB TOTAL $ � <br /> SUB TOTAL 5 � T� <br /> �OG <br /> PEAMIT S � <br /> - PERMIT 5 ' I� TOTAL FEE $ ' <br /> TOTAL FEE S <br /> 9�1� <br /> FOR OFFICE USE ONLY: AECEirr No <br /> fRONT SETPnCK PC�R SET04CN 9DE SEIDACK <br /> PL�NGIIECKNUMOGR �fF <br /> IOTAREA VACANISRE <br /> FEES VALUATION �EE_�___ <br /> USE ZONF. ��yE5 I 1 NO pp��plNC 1 <br /> 11[IGNT LIMITATION NO OF UWELLING 512E O!OLIX:�1 � <br /> UNIfS �IUMpING --�— <br /> i <br /> i <br /> OCCUPANGY NO��f SIORIFS OCCUP4NT LOAD PASEMENT MGCIInNICPL � _-- <br /> i <br /> GROUP IIYES I1 NO � <br /> A�OIIIONAI.�'LAN CNf.CK <br /> - �_�'_— <br /> FlRE AIARM REO'D RFASOY � <br /> OINEfi � <br /> FltiF51'�INKIERPF.O'I1 �F�SON STAlE011qDRIGSURGH40GE <br /> �vreorr,oNsr rinNsnrrnoveonv CITYOFEVERETT runnr,wonKs ,_1_- <br /> LOCAL SALES ' <br /> un�E <br /> TAX CODE IS 3105 TOiAI �— <br />