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.-� <br /> APPLICATION FOR CONSTRUCTION PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STHEET• EVERETT, WA 98201 •25J-8810 <br /> f I DEMOLITION fl COMBINATION fl BUILDING MECHANICAL r 1 PLUMBING f 1 SIGN <br /> PROJECT AODRESS _ <br /> -U P. <br /> ��ER MI11l�ODRE55 pTY 71P PIIONE <br /> Ju��a►� du�Z�a�au�c �2 8�0� �MFs�so� P� �vr�c�, vJa �i�ao� 5�3 a5� <br /> 1EN11NT Ml111,ADOqE55 f.I1Y ZIP {`IIONE <br /> MC <br /> �PCN�7ECTORUESIGNER MML�ODRE55 cm zm m�oNE <br /> GENEf1µCONTMCTIXi M�IL�D[NiE55 CIIY 71P pibNG SIRIEIICENSEI <br /> �.F_ �� <br /> MECNIINIC�LCONtqR�TpR M�ILAI)pRESS CITV 711` PIIONE STIITF.LICCNSF� <br /> PLUMBINf3CONTR�CTOR MAIL�DDpESS CIIY 21P PNONE STAIEUCENSE� <br /> CONTRACT PFICE CF WpRlt <br /> SIoO • � HEATING SYSTEM: I I GAS f 1 EIECTRIC f <br /> OEYSCRIBE N9RIf AND 5 ARE FOpT�6E MVOLVE6 CONTRCT i`ERSONANO PIIONf.NO <br /> j '� – � <br /> T lt W�T � <br /> I HEREBY CERTIFY THAT I HAVE READ ANO E%AMINED THIS <br /> PHO{'OSEOIISE OF BUILpNO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECi.ALL <br /> PROVISIONS OF IAWS AND ORDINANCES GOVERNIN6 THIS TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN Ofi <br /> LEO�IDESCPoPTONOFPRpPEpry�$�qWyPELOWOR�TTACHTVqCOPIES� NOT. THE 6RANTINO OF A PERMIT DOES NOT PRESUME TO (iIVE <br /> ior eioac oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAI LAW REOULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF(:ONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPUCATION IS MADE AND I COtAPLY WITH THE STATE <br /> PAHCEL TA%1.0.NUMBER CONTRACTORS LAW 1827 CW AND 296200 WAC. <br /> ��as- o�b -o�s- oml, x Q , �-� - � �, <br /> CONSTRUCTON IOAN IENUER,�Uq1ES5.TELEMIONE MIMBER <br /> 51(3N�lURE O�tE <br /> CITY BU51/1E55 LICENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FlXTURE OR�TEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLOUNITS—H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> i <br /> LAVATORY(WASH BASIN) r HEAT PUMP , <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CIOTHES DRVERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> IAUNDRY TRAV � RANOE HOOD ; <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WO00 STOVE � <br /> DRINKINO FOUNTAIN i METAL FIREPLACE(WOOD BURNING) ; <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNINO) � <br /> BACKFLOW PqEVENTERS ; OAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS RANOE � <br /> ' dAS PIPINO ' <br /> i EXHAUSTFAN � <br /> � � <br /> � ; <br /> � � <br /> � , <br /> SUB TOTAL S � SUB TOTAL S � <br /> PERMIT 5 � PERMIT S � <br /> TOTALFEE 3 ' TOTAIFEE S � <br /> FOR OFFICE USE ONLY: <br /> fpONTSFTPACB RFIIRSFTP�CN $�DESFTP�CB Pl�NC11ECRN11Mflffi fGP f1FCFlPfNO <br /> 5a�31 <br /> usexor+e iot�ne� V�C�NtSIIE FEES VAWATION FEE <br /> _ IIYES ii NO p111LUING i <br /> � <br /> IIEIGIIT UMITATION NO.OF DWELLIN(7 SIZE OF BLIXiRI � <br /> IINI(S <br /> PLIIMIIMC � <br /> i <br /> OCCIIPANCY NO IX SIMIIES OCLUP�NT�O�D RAbi MENf ✓ �F <br /> (:f10�m MECII�NIC�L 9` � <br /> I IVES I I NO '--' -"--' '--1�-�_-i—.. <br /> i <br /> fIRE�LMMRWD I1F.ASON ��fN110N�LPi�NC��f.f.K i <br /> 'i'_'"' <br /> onien I <br /> fIRF.5PPoN1(lEOREOD qFA50N __i-- <br /> � <br /> SiNE Iillq pIN.SUfIC11110f.E � <br /> � <br /> _� __ <br /> TVI'EOFf,ONSt PI�NS�f'1`f10VE11BV CITYOFEVERETT �II�IIf,WIlf1HC � <br /> LOCAL SALES ----- ----�—-- <br /> o�rE TAX CODE iS 3105 TOTAL ', <br /> �-- - <br />