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APPLICATIL�1 FOR CONSTRUC7 �ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> f] DEMOUTION fl COMBINATION � BUILDING I� MECHANICAL �l PLUMBING f 1 SIGN <br /> PROJECTAGDRESS '�� �NC�LdND ,lS�/�, '��JE�Q„�"� <br /> OMMEP M�IL�ODRE55 Cltt ZIP PMONE <br /> �sn�py � �sm c.o2c.sT��'� S�E ,as �ovC <br /> TENANT MAILADORE55 CITY 21p PIIONE <br /> ARCHITECt OR�ESIGNER M�IL A�ORESS GITY ZIP PIIONE �U� W I /q�d <br /> Tv'fVn,d2G QSS.�L. IocZo w�/SI N ST #k'Zol RyE�c• � n��a l"12Gj <br /> GENERALCONTMCTO{7 MMLAOORESS CIIV lIP PIIONE SiRiLLICGNSE� <br /> 5�+�� �S l�Fs��lL T�TmA�I �`t Z Mal <br /> MECHANICALCONTPRCTOR MAIL�DDRE55 Cltt 7.IP PIIONE STRTF.IICENSE �1(�� <br /> r1, ,d • 1�29�1ro <br /> PWMBINGCONTR�CTGR MRILADORESS Cltt ZIP PHONE STRTELICENSE� <br /> N . ,� . <br /> CONTMCT PRICE OF WORK <br /> � 2 -rj � o O o HEATING SYSTEM: f I GAS �l ELECTRIC rl N•�1 • <br /> DESCRIBE WORK�NO$OIIARE FOOT�GE INVOLVEO CONT�CT PERSON�N�PNONE NO <br /> ST�A2T C-�E2C�E2 ►��k�T�srm�c. <br /> G�NSTR UG7' Y,d2D � G<32pE n� h, ��c� I^I Zcj 'F'4x 6SSfS 1 '�l�j� <br /> �.JON• HABITA �^' gT V U l I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> Q�cK.E 2 i GS} sporLr GoJr APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT ALL <br /> PPOPOSED USE OF BUIl01NG PqOVISIONS OF LAWS AND OPDINANCES GOVERNING THIS TVPE OF <br /> �.�G12�,C�T1'DI.� WORK W�LL BE COMPLIED WITH WHETHER SPECIFIED HEREIN Oli <br /> lEOALUESCRIPTIONOFPROPERTY�SMOWNBELOWOR�TTACNTWOCOPIES) NOT. THE GRAN7ING OF A PERMI7 DnES NO7 PRESUME TO GIVE <br /> ioTs 'r'� �� BLOCK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> S� �RGS � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEFi OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PNICELTN(ID.NUMBER -ygzqo � '0 3 Qeo�"� CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> �1� '3 29� � '03� `Jo�'1 /� � <br /> CONSiRUCTION IO�N LENDER.ADDRE55.TELEPIIONE NUMBER Q L� ' �Q-f S <br /> SIf.N� R DATE <br /> CITY BUSWES$L ENSE N . <br /> PLUMBIN6 MECNANICAL <br /> NO. TYPE OF FlXTLRE OR REM FEE NO. TYPE OF EQUIPMENT FEE <br /> O WATERCLOSET(TOILEn ' D A/C—A/HNDLGUNITS—H.P. ' <br /> o BATHTUB ; 0 FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> i <br /> o LAVATORY(WASH BASIN) � c HEAT PUMP � <br /> n SHOWER ' � UNIT HEATERS—B.T.U. M ' <br /> o KITCHEN SINK E DISP i o CLOTHES DRYERS i <br /> � DISHWASHER � o VENTILATION FAN ' <br /> o LAUNDRY TRAV ; o RANGE HOOD � <br /> o CLOTHES WASHER � p WATER HEATER � <br /> o URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i o METAL FIREPLACE(WOOD BURNING) i <br /> � FLOOF DRAIN � O FIREPLACE INSERT(WOOD BURNING) ' <br /> o BACKFLOW PREVENTERS � y GASFIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � � GAS HANGE � <br /> o GAS PIPING ' <br /> i p E%HAUST FAN � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL $ ; <br /> PERMIT S i PERMIT S � <br /> TOTALFEE 5 ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FPONTSETPACK � RE�RCFTO�CK SIOESET�Rf.J� �IANCIIECg NUMOF.R fEE � �ECEIPTNO <br /> 7� � � J � `-����3� /7�/� <br /> usezor�e torenen V�CRNfSITF FEES VALUATION FEE <br /> i <br /> � fIYf.S 11N0 OWLOING � <br /> — 3B'YG' � <br /> HEIGIITLIMITAG% � NNIi�UWEtLING SR[OFOLDGRI � <br /> t`t4 Sf- 0✓�Oviui.va rwr.inwc <br /> od s t�2:�c w — -I <br /> OCCUPANCY NO Oi510RiCS OLCUPANTl04U BnSEMGNT i <br /> Gf10UP M[CII�NICAL i <br /> . p a iives i� � <br /> FIREAUPMREO'D Rf�50N AIJUIIIONMPUNCMf.CK i _ <br /> O1HEF1 � <br /> FlPE SPRINNI.Ff111E0'� RF�SON i <br /> STG1E OUIIDMG SUpC11Mf.E �lJ� <br /> IYPEOFf.ONST PUNSAPPROVF.OAY CITYOFEVERETT ruanr.wonKs <br /> .Q N LOCAL SALES <br /> onrE S �9 ' TAX CODE IS 3105 ToiAL <br />