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APPLICATI�,.d FOR CONSTRUC? .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOLITION fl COMBINATION Is7� BUILDING f�MECHANICAL fv�'pLUMBING f 1 SIGN <br /> PROJECT ADDRESS <br /> �It��� �l, Cf�P\Tf�N I�� I�`{ � �Et� ��ZC� �AS�M�NT \ <br /> � � E�IE �h;.� �1-�OE ) <br /> OWNER MRII,pODAESS CITY 21P PHONE <br /> COMM\�N\-C`1 �T(Li\N oonEss `I�'� 1�9�-\{��SZ Sti� F�Z.ob � �`1NN��OOi� �11'�0'�`� <br /> �;�/c� <br /> ARCHITF.CTORUESIGNER MAl1.A�ORE55 GITY ZIP PMONE <br /> ��i��. ����� ,�� c -��Mu�� �, �--c��s�T ����--z�Z zz�� � <br /> GENEf1ALGONTf111CTOR MAILAOOPE55 C11Y IIP PNONL $7A1ElICENSE• <br /> � �!�me� <br /> MF.CHANICALCONTRACTOR MAILA��RE55 CITV ZIP PIIONE STATEUCENSE� <br /> PLUMBINGCONiRPCiOR MAllA0DRE55 CI7Y ZIP p110NE STATEUCENSE• <br /> CONiR�GT PRICE OF WORK <br /> �5 , �.O _�� � HEATING SYSTEM: f l GAS i✓E�ECTRIC fl <br /> DESCRIBEWORNAND50VAREFOOT�GEINVOLVED CONT�CT SONA PIIONF.NO <br /> - C ^ i�Z � S <br /> �`- I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED TH�S <br /> PROiqSED USE OF 6111101NCa APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> �� „ � � G� �j PROVISIONS OF LAWS PND OFDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br /> LEGRLDESCRIPTIIXJOFPROPEflTY�SHOWNBELOWIXiRTTRCH7WOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oi BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> c�� •� PEiiFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCEL TA%10.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> 'V\ /Gl <br /> CONSTRUCilON10RNlENDER,ADORESS.TELEFHONENUMBER X <br /> SIGNATURE DATE <br /> QTV BUSINESS LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATERCLOSET(TOILEn � A/C—A/HNOLGUNRS—H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � � <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNITHEATERS—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 � MEIAL FIREPLACE(WOOD BUfiNING) � <br /> } FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS � GAS FIREPLACE ' <br /> SINK(SERVICE—BAR. ETC.) � GAS RANGE � <br /> GAS PIPING ' <br /> � E%HAUST FAN , <br /> � � <br /> SUB TOTAL 5 ; SUB TOTAL 5 ; <br /> PERMIT S � PERMIT 5 � <br /> TOTAL FEE S � TOTAL FEE S � <br /> FOR OFFICE USE ONLY: <br /> fRONTSFTPRCN � PF�RSF.IDALK SIUESETBFCR PIANCIIELKNUMOfR FGF � PFCEIPTNO <br /> � � ID� O � .f /C1�5G0Y � / <br /> USEZONE, ^7 lOiAf1EA VAC�Nf51IE FEES VALUATION PEE <br /> ' (� f jAES (1 NO pUIIDING /)� 04 � -/� � <br /> oV L <br /> IIEIGNT UMIUTION � NO OF OWELLING SIZE Of BLOGT � <br /> SUNItS (�(/1 � pWMpING i <br /> �.� 1 <br /> OCGUPANCv 110 Of S�OaES OCGIIPAN IOAD BASEMEN� T <br /> GROI P MFCIIANIC�L <br /> i <br /> I1vE5 NO <br /> i <br /> FlRE�IARM PEO D fIF�50� ADDI710N�L PUN C��FCR � <br /> i <br /> OiNEfi � <br /> FIRF.SPRINNIERRF.OD RFAcON <br /> �O STAIEflUIIDIN(i5VRC1UfiGE � /.�/1 <br /> \l / <br /> _ �.t <br /> �vveorr,oNST rtnNsarrnovFnor CITYOFEVERETT runi.ir.wonKs � <br /> � �M LOCAL SALES -�— <br /> unre TAX CODE IS 3105 707AL 2Z ':J D <br />