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� � <br /> APPLICATIO�! FOR CONSTRUC? �ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> i <br /> f�l DEMOLITION �l COMBINATION IYEUILDING I� MECHANICAL r 1 PLUMBING f 1 SIGN <br /> PROJECT ADDRESS <br /> 7/U F_ /�W/>C�� <br /> owr+en MAILRDORESS cm nr r��oNc <br /> �':0�5C �e�Zoll� ��o �DWA20S Everek� 44��f 33� - 0163 <br /> iENANT MAILADDRf:55 CI7Y 21P PIIONE <br /> ARCNRF.CT OR OESIGNER M�II AODRE55 Q1Y 71P PHONE <br /> GENGR�LCONilUQO/R - MMI/A�U/RE55 I CILY���y� qllP PIION[ $iA1GLICGNS[• <br /> �0.G.1�i L �J'[.criCpl lj�b �.CtUe�l 1�2. �VCl`Cil �' lfS� r 7-� 1 - �3�� ��l1=6f 6f5&JN <br /> MELHANILALCON7R4CTOf1 'd MAILADDRE55 CITY ZIP PIIONE STnTELICFNSE� <br /> PLUM9INGCONiRAC10R MAILADDRE55 GIIY 21P PIIONE STATEIICENSE• <br /> GONTRRCT PRICE OF WOf1K <br /> �L��. u� HEATING SYSTEM: I 1 GAS f 1 ELECTRIC f i <br /> DESCRIBE WORN AND SOUARE FOOT�GE IRVOLVEO CONT�GT PERSON ANp PI10NF NO. <br /> oirs Uc �3� � G-Ar_nb� <br /> 352 ' - FO D!_-oN 7sS � _;�i <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSEO USE OF BUILDING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> G� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRIPTIIXJOFPFOPERTV�SHOWNBELOWORATTRCNTWOCO�IES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BIOCK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRIICTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MAOE AND I COMPIY WITH TfiE STATE <br /> PARCEITAX I.D.NUMBER CONTFACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> 3 0�z 5�- �3- 6 2�- a 1 <br /> CONSiRUCiION LO�N LENDEA.AO�RESS,TF.IEPNONE WJMBER � �� �-/7� S`C' <br /> x <br /> SIGNAIURE D fE <br /> �( � ` /��`� CITYDUSMESSLIC@NSLNO <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. 7YPE OF EUUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNIT5—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(VlOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE _T <br /> SINK(SERVICE—BAR.ETC.) � GAS RANGE ' <br /> ' GAS PIP�NG i <br /> ; EXHAUST FAN � <br /> � ' <br /> _. � � <br /> � <br /> SUB TOTAL 5 ; SUB TOTAL 3 � <br /> PERMIT S � PERMIT 5 � <br /> TOTALFEE $ � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: �'� ��� <br /> rnonrsernacK nrnnsrrnncK sio�sernncK ri.,u�c�iEc Ny�unm rE�� `r� nEccmrNo <br /> � , 5' � � „ '� <br /> usezor+� nen vncnNrsire FEES VALUATION FEE�JT_ <br /> �—i C,.aO i ives ,� No nunmr+c �� r t r� O i0 �0 I pc7 <br /> NEIGIITUMITRTION NOOFUW@LLING SIZEOfAlUC141 <br /> ZI llNliS 1 � ( E. f`IUMOING __ i <br /> � , <br /> OCCUPANGV NO OI S�ONRS OCCUPANI LOAD ORSEI.�F.NI MECIIr1NIC�L � <br /> ` ' i <br /> GROUP ( IV IA �O _- - <br /> _I I ItiFS � <br /> �ODIIIONM PI�N CIIf.CK � <br /> fIRIiALAf1MRE0l1 RF�SOY , <br /> �_� <br /> � ' <br /> omm� <br /> rmi:svnuukiennron nrnsor+ <br /> I� sini[nunon+r.sunamnce ;�J <br /> \ <br /> m�Forco�+sr ainHsarrnov[npr CITYOFEVERETT i�unncwonKs ' <br /> V I� LOCAL SALES -- — ---?�., ' <br /> _ —1�1 rnre 8 9S TAX CODE IS 3105 TO7AL__ _ __ ___� <br />