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APPLICATILnI FOR CONSTRUC7 .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOUTION f 1 COMBINATION I-I BUILDING fl MECHANICAL r 1 PLUMBING f 1 SIGN <br /> PROJECT ADDRESS <br /> �.50� L''vcaEf�- !�v-e C���-� �,/�. 9Q'zo/ <br /> OVMER MRILADOPE55 GITV 21P PNONE <br /> ��n� ��'�w�.es J�cNv� ic5 �o. (5ox 533 �„�efrw� y'8�6 �.s8 � 7oyl <br /> tNnNT AIRILADORE55 CITV IIP PIIONE <br /> ARCNITECT OR OESIGNER MAII AODRESS C17Y ZIP PMONE <br /> GEN A�CONif1ApTOR MRILADDRESS CIIV )IP p110NE SiAiELICENSE� <br /> I,�n-C1�J <br /> MECNANICALCONTRACTOR MRILqDDRE55 CITV ZIP PHONE STATELI�ENSE� <br /> PLUMBINGCON7RACTOR MAILADURE55 CIfV 21P PIIONE <br /> STAiE LICENSE• <br /> CONTRACi PRICE OF qK <br /> �3�/2' ��¢, o W Ne 2 �o�„� /}L� WD HEATING SYSTEM: f l GAS fl ELECTRIC fl ��N e <br /> OESCRIBE WOqK qN0 SOUr1RE FppTAGE INVOLVED CONTACT PERSON�ND PHONE NO. <br /> s�o SS F_oo��a,�a�e <br /> uNl� cSio�ti e ow� <br /> I HEREBY CERTIFY THAT HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSE OF BUILOIN APPLICATION AND KNOW THE SAME TO 8E TRUE AND COFRECT AlL <br /> CIXe �- ��� y�W e PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGIILDESCi11PTIqJOFPROPERTY�SHOWNBELOWO{7ATTqCHTWOCOPIES) H'ORK WILL BE COMPUED WITH WHETHER SPECiFIED HEREiN OR <br /> 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 /> OTHEfi STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATIOM IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%I D.NUMBEF CONTRACTORS LAW 18.27 RCW A 296.200 WAC. <br /> 202 9 -0 '2- x (�,� - ,���.,�r--r <br /> CONSTRUCTION LOAN LENUEq.A0URE55,TELEPHONE NUMBER ��S �S� <br /> SlGywiUNE DATE <br /> Cltt Bl151NE5S UCGNSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fl7(TURE OR ITEM FEE NO. TVPE OF EGUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNRS—H.P. � <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 6 DISP ; CLOTHES DRYERS ' <br /> � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> � <br /> CLOTHES WASHER � Y1�ATER HEATER , <br /> URINAL � WOOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINN(SEFVICE—BAR,ETC.) � GAS RANGE , <br /> ' GAS PIPING � <br /> i EXHAUST FAN ' <br /> i <br /> i , <br /> i � <br /> � , <br /> SUB TOTAL $ i SUB TOTAL 5 � <br /> PERMIT $ , PERMIT $ � <br /> TOTAL FEE $ � TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONT SEiPACnK ,.� ' qEAR SETBACN SIDE SET84CN PIAN CHECK N�C:R fEG O� RF.CHPT NO. <br /> C.J� �, /� ' d' S� <br /> usezoNe , f iornnen vncnNr=_ir� FEES VALUATION FEE <br /> _ —'-Y OOD r i res r r�o ounowc e'! ,5 G] ' OlJ <br /> NEIGHT(,IMITATION � NOOF�W[ILMG SIZEO�OIUGrtI _ � <br /> 21 UNIIS / 'C � C! PUIMOING � <br /> � �I- � <br /> OCCUfANCY NO Ot5tOR1C5 OCCUPRNiLOnD OASEMENT � <br /> GROUP � MBCII�NICAL � <br /> '� n I1VE5 JyNp � <br /> FlREAUFMRE00 RfA50Y �ODIIIpN�LPL�NCNECN � <br /> i <br /> i <br /> on�en ; <br /> fIRF$PPINKI[R REO'D RFA$ON / ! <br /> STATE O111L�MG SURGNMGE �� <br /> tvreorr,or+sr Pinvsnnrnoveonr CITYOFEVERETT runur,wonKs � JO� <br /> p_� �J I�" LOCAL SALES —— <br /> uaie TAX CODE IS 3105 TOTAL / �� '} 'J�J <br />