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APPLICATIvN FOR CONSYRUIC'� ION PERMIT� <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 '��" <br /> fl DEMOLITION COMBINATION �BUILDING �I MECHANICAL t� PLUMBING fl SIGN <br /> PROJECT ADDRES <br /> lovo 5. . ���rL�TT Maw WA-( - bw�r.Z F�. I EJERET'( <br /> OWNEP MRILApORE55 cm zir rr�or+e 2�(i Z � PlyO <br /> J�.M��� P���1��rEIZ G/oGo�l,��� YX/o GIFTN A�/E. ht�ItE3 3a SE.Q.�f'(�E <br /> �ENFNT MNLRfJDRE55 CITY ZIP P��ONE �Zp(0� ���' �GVO <br /> �iTY UNi��KsiTY �J�J�J -IICoT��°'�/E ✓•E.� 6El.LEV�IE__�V•Il�.. f�ooq- <br /> PRLHRCCTOR�F.SIG11[R IAAII.RODRE55 CILY ZiP PNO F. 'L� �j O � � <br /> GUtiIrJEt-I. VESllahl Gfeo�IP 22voo.(o,f,r�A�/E.t�I�J�MaUt�'rI,AKE '�ERV-o�[-� '�Pir/�3 <br /> GENERn/LCONTMCiOfi MRILADORE55 C�rv ZiP PIION[ $tATEIICENSE• <br /> 1 l O � <br /> �fECHANIC�LCONiRACTOR MAILADDRE55 f.ITV Z6` PIIONE SiRELICENSE� <br /> PWMBINGCONiRAf,TOP MnILADDRE55 CIiV ZIP P110NE STA7ELICENSE� <br /> CONifinCi FRICE OP WORK <br /> 2 Upp, �o HEATING SYSTEM: f 1 GAS �l ELECTRIC (l <br /> DESCP3E WORK RN�SpI1r1RE F00T4GE INVOLVED CONTlGT PERSON ANU PHONE NO <br /> I c�3 I ��. F• N E W TEN,a i�I �� � <br /> IMPrLoV�M�N P�I�ILf7 -OUT �ZaC� ) Lo O - (o OL! <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSED USE OF Bl11LDING ✓ `/ PROVISIONS OF LA'.NS AND OFDINANCES GOVERNING THIS TYPE OF <br /> EDUGA'�IvNAI. rAC�I L177 WORK W�'.L BE COMPLIED WITH WHETHER SPECIFIFD HEREIN OR <br /> LEGRLDESCRIPTIONOFPROPERTV(SHOWNBELOWORATfACHTWOGOPIFS� N6T. THE GRANTING OF A PERMIT DOES NOT PRERUME TO GIVE <br /> ioT d�aK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LUCAL LAW REGULATING CONSTRUCTION OR THE <br /> G �J �� ' I PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS M DE AND I COMPLY WITH TI1E STATE <br /> PA{10ELTA%I D.NUMBER CONTRACTOR LAW 1 2 RCW AND 296200 WAC. <br /> IY�Z���'�' ' 3 — or�¢ , U�UZ �/ ���J� /] <br /> CONSTRUCTION LORN LENpER,ADORESS.TELF.PHONE NUMBER /J V���I, <br /> SIGNFTURE �AT� <br /> CITY CUSINESS�ICENS[NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVA70RY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SI�K&DISP i CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN ! <br /> LAUNDRY TRAY ' RANGE H000 i <br /> CLOTHES WASHER i WATER HEATER ' <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOU�:"�AIN METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFIOW PREVENTERS ; GASFIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE <br /> � GAS PIPING i <br /> i EXHAU�T FAN � <br /> _ i i <br /> SUB TOTAL 5 � _ SUB TOTAL 5 <br /> PERMIT S PERMIT S � <br /> TOTALFEE S � TOTALFEE 5 ' <br /> FOH OFFICE USE ONLY: � <br /> fRONTSE7FlACN PEFRSF.TpACK SIOESETDRCN �INJp/�E�NNUM [fi �EF . �j R[CEIPTNO. <br /> �7 J� ` <br /> usEzorve io.nr+en vncnr�rSrtF FEES VALUATION FEE <br /> fIYES f'� NO �/.� � i <br /> OIIRpM6 �� � <br /> HEIGIR UMIlRTION NO OF OWELLING SIZE OF filDGrtl � <br /> UNIiS �/��� ��. p1UM.��NG _ { <br /> ( � <br /> OCCl1PANCY NO 0[S10f1iES OCCUPANi LOAU B45EMENT MEGI�NICAI i <br /> �,o��� 7.'l. 1�a8 T.l. — ---�-- <br /> I1TE� y�NO <br /> fIR"eALF MRE00 REASOY PODILIONAIPL�NGIF:CK <br /> {(�/��//� /��� � �— <br /> l�% Y�cI��/ ' Ot1�EP i <br /> PIRFSPpINNIERREO'D RF�FON � <br /> YI�� 1�.�/)�j� STFTEl3UIlOR1G SURC,IIMG[ ! �1 ') <br /> C L"lV.� 1sV <br /> rvreavr,oNs* r � ninNsnrrnvenor CITYOFEVERETT runur.woeKs � <br /> � � � � LOCAL SALES — - -7 ���-,� <br /> enre -3 I3 C1 TAX CODE IS 3105 TOTAL �� -/ � '�.,(i <br />