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1�I�PLICATIO�d FOR CONyTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> f7 DEANOLITION COM@INATION fl BUILDING f� MECHANICAL fl PWMBING fl SIGN <br /> PROJECT ADDRESS <br /> i E Yhor,Z LpNE <br /> � �'�(SE�/4n+ai 1 J �jC�(/�.+ .5�al�M�l.ti0 y F�MOiv m�oNE C�7rs�' //oZ\ <br /> D.s �c�o <br /> IENAPoT MAII �:� AF.55 CI 21P PNONE � <br /> RRCHITf.CTORD IGNER MP^ILADORESS Gltt )IP PNONE � <br /> ��-s ���,W�s I7/J Ihb��50N tu�sr ��o� �sa -�osa�/ <br /> GENERAL4,Q�iMCTOR MAILAUORE55 C17Y )IP p110NE SfAT[ULENSE� <br /> 2n,na��(.,,,..� ni.sTa��J�� 1�-in.,E C�v.+oru�s 9�ooio �f�-/o��. Z�Mw�EeT_o6/kS" <br /> MECHANI�ALCONTRACTOR MRIIADDRE55 CITY ZIP PIIONE STATELIC[NSE• <br /> �N�' O�'^�a� � .(,a.) . L A�WaOD E�O� <br /> PLUMBINGCON7RACT0 A��RESS CIIV 21P pHONE STATEIICENSE� <br /> `� , �' �. sd FZ�?' Ar�.�,�o_ �s-��7/ 2p��E-�-a e <br /> CONTR�CT PRICE OF WOI1K <br /> HEATING STEM: �GAS I-1 ELECTRIC f"1_ <br /> DESCRIBE WORK PNO SOUARE FOOTAGE INVOLVED CON PFf1S0 0 PHONF.NO. <br /> p � —`?/ .� <br /> OI T �E�L ��SE <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMIN=_D THIS <br /> PROPOSEDUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AN�CORR'eCT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDE' TIONpFP(70PERiY�SHOWNBELOWCopw ACNTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or�etocK 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 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PEPFORM THE WORK FOR WHICH <br /> • APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEI T�J(LD.NUMBER CONTRACTORS LAW 1827 RCW AND 296.20G WAC. <br /> � o �b�"O00 <br /> CONSTRUCiION LOAN�ENDER.�UDPESS,TECEPHONE NUF�BEq x �µ� � ��H����� Z�,/Q� <br /> SIGNAlURE DATE � <br /> CIN BUSINE55 LICENS[k0. <br /> PLUMBINCa MECHANICAL <br /> N�l. TVPE OF flXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) / � q/C—A/HNOLGUNRS—H.P. � <br /> BATHTUB I ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � , <br /> LAVATORY(WASH BASIN) /I/ � HEAT PUMP , <br /> SHOWER / � � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP � / CLOTHES DRYERS ' <br /> DISHWASHER � VENTIIATION FAN � <br /> LAUNDRY TRAV ; � RANGE HOOD ; <br /> GLOTHES WASHER WATER HEATER <br /> URINAL ' WOOD STOVE <br /> DRINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) i <br /> _ � FLOOH DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFIOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � ( GAS RANGE � <br /> i <br /> � GAS PIPING ' <br /> � E%HAUST FAN � <br /> i � <br /> � � <br /> � <br /> T <br /> SUB TOTAL 5 ; SUB TOTAL 5 ; <br /> PERMIT S � PERMIT S � <br /> TOTAI FEE $ � TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: jb� 73 <br /> fRONT5ET0�CN REARSFT�RLK S�DESETBACN / PUNCIIECNNUAIOER p fEf '/ �PECGIPiNO <br /> �� 7 S .�J iJ� J 7• <br /> USE20NE LOTRfiEA VRCANi511F FEES VALUATION FEE <br /> Q.' S r� no ounn��+c I 13 �lo �7� � S"J <br /> IIEIf11T LIMITATION NO OF DWELLING 512E O��l RI i <br /> ?8 uN�r� 2m3i °�r. Livinl4�- ��c3- ✓'r� <br /> 75 F. G G` rwiaoiHc ,� <br /> OCCUPANCY NO Of5I0NFS OCCUPANTLOAD BASEMENI � D � � <br /> ff10UP M[CNnNICpI ,� <br /> Iz-3 �-I 2 N q. ��YES .,.� �-� <br /> � <br /> FIREALARMREOD RGA50Y MD�IIONRLPIANCN[CN �D � 9,� <br /> 1 ___ <br /> O7NER <br /> �IRESPRINNIF.RRE00 RF�SON � — <br /> STA1G OUIL�INO SURCHMf.E <br /> 1 �, � <br /> irreorr,or+sr rinNsnrrnovenov CITYOFEVERETT rimnr.wanes 1r7 �,.�_�:> <br /> J� LOCALSALES — �— —n� <br /> –/..� opTE 3 /3 (o TAX CODE IS 3105 TO7AL ��J�`� � -j�� <br />