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� � <br /> APPLICATIOr�I FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 982oi • 259-8810 <br /> Q21 DEMOLITION fl COMBINATION I-1 BUILDING f�l MECHANICAL �� PLUMBING fl SIGN <br /> PROJECT ADDRESS ��, D �J�s, � /J n � <br /> i-�r--� <br /> OWNE,R,� M�LLADDPE55 CITY ZIP PHONE <br /> /�/r,�.cv!i c� ��vr� f�'`"J�, � �Gynnwoo.�� 9�O�lo <br /> TENIINT MRILADURE55 f.ITY � ZIP PMONE <br /> ARCHITECT OR DESIGNEP MRII.A�DRE55 GITV ZIP PMONE <br /> GENE��T�UCTIO.L�AILA��iS�wCIA�� /�'\/'IiV �� 21P ���ION��I $IA1ElICENSE� <br /> AJ�'J � a <br /> MECNANICAI CONTRACTOR MRIL RDDRE55 CITY ZIF PIIONE $TAtE LICENSE� <br /> PLUMBING CONTRRGTOR MRIL RDDRESS CIN 21P PNONE STATE IICENSE• <br /> CONTR�CT PRICE OF WORK <br /> HEATING SYSTEM: I l GAS rl ELECTRIC �l <br /> DESCRI9E WORK ANO SOU�RE FOOTAGE INVOLV[0 CONT�CT PERSON AND P110NF NO <br /> h�O <br /> I HEREBV CERTIFY THAT 1 M.'.`�E READ AND EXAMINED THIS <br /> APPUCATION AND KNOW THE SAME i 7 BE TRUE AND CORRECT.ALL <br /> PROipSEDUSE OF BUILOING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPl1ED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�lDESCRIPTIONOFPROPERTY�SHOWNBELOWOR�TTACNTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> �� / / OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � / z /(,�g � PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> ��"' �`�/ �y� ��J � CONTRACTO R I AW 8.D27 RCW AND 29G.OOLWAC. ITH THE STATE <br /> PARCELTA D N/U��/1BER ^' / <br /> ��O ' W ���C ' � a " / � <br /> COMSTRUCiIONIO�NLENDER.ADOHE55.TELEPHONENUMBER / <br /> 5`GNATU DATE <br /> qTY 9NE55 LICENS[NO. <br /> PLUMBINO MECHANICAL <br /> NO. TVPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLOUNITS—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 i CLOTHES DRVERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> � UUNDRY TRAV ; RAPIGE HOOD � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> ORINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS i GAS FIREPLACE i <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE ' <br /> GAS PIP�NG � <br /> � EXHAUST FAN � <br /> i ' <br /> � � <br /> � <br /> SUB TOTAL $ ' SUB TOTAL $ ; <br /> PERMIT $ � PERMIT S � <br /> TOTALFEE $ � TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSFTP�LN PEPRSFTBACR SIDESETBRCN �'LANp1EC NUMOER FEE AECEIPiNO. <br /> �r� v <br /> USE20NE iornaen wcnNrste 1=EE5 VALUATION FEE <br /> f1YES (i NO i <br /> OUILOING <br /> NEIGIIT LIMITAiION NO OF OWELUNG SIZE OF BLDG41 � <br /> IINIfS pLVM01NG <br /> � <br /> OCCUP�NCY NO Ot SIORiES OCCUPRNT LOAD BRSEMENi � <br /> GROUG MECIIRNICRL � <br /> f1YE5 Il NO � <br /> FIBE�LI1RM REO'D RGSO4 <br /> AUDIIIONAL PLAN CNf.CN � ' <br /> O1HEli i <br /> f1I7F.5PRINKLERRE70 �EASON � <br /> STAIE OUIIDMG SIIIiC11r1qGE � <br /> imEorr,or+st rinHsarrnoveoev CITYOFEVERETT runnr.wonKs 1 <br /> LOCALSALES ; <br /> ontE TAX CODE IS 3105 TOTAL ' <br />