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APPLIC/�TION FOR COW��'R'JCY�ON PERNl�T <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STRE�T• EVERETT, WA 98201 •259-8810 <br /> � fl DEMOLITION fl COMBINATION fl BUILDING f-I MECHANICAL �PLUMBING f l SIGN <br /> PROJECT ADDRESS <br /> /O DG _SC EU e,�e f-f l�17C�// �' �- �� <br /> OW4ER M 1C DPESS nn ���- . <br /> � ' � , S' l -�j-`��'' �L�L', #1��I� P � Gc.. /ii/ <br /> TEN4Mf MNLpODRE55 CITY 21V PHONE <br /> �/i ��ixt�/L��,-i /���a,n� i/� sr ��-��ai� � �-iai �t�ak ,�- <br /> ARCHITEC7 OR f1E51GNER G MPII qODFE55—��— ��ry zlp I PHONE i--�2�-/� <br /> GENEPALGONTlIACiOq MlILAOORE55 f,liY ZIP PIION� $tATELICENSE• <br /> MfLHPNICAIf,ON1RAC1'OP MFILA�ORE55 CITV ZIP PHONE STRELICENSE� <br /> �_ v�2�v� /rnq �iGY��/ �1/E /S Sf � <br /> � L_._L2P�/ncv��/ C�� 9�G�s$ g�� n�,c i i,�.�. �.,. �,or�c <br /> Pl11MUIbG-C�F:IRACTOR - AILAOpRE55 CI�Y ZIP PHONE STATFLICFkSE• <br /> �LJCJ� <br /> CONTRP;;T PPICE OF WORK <br /> HEATING SYSTEM: � 1 GAS fl ELECTRIG f 1 <br /> Ch:SGRIBE WORK AND SJV4P.E FOOTAGE INYOLVEO CONTACT PERSON AND PNONE NO. <br /> /.� t /21' q,E' - � .�C <br /> I HEREBY CEFTIFY THAT I HAVE READ ANU EXAMINED THIS <br /> PROPOSEL��USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TNUE AND CORRECT ALL . <br /> �(��e PROVISIONS OF LA1NS AND ORDINANCES GOVERNING THIS TYPE OF <br /> — WORK WILL BE COMPLIED IYITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDFSCRIPTIIXJOFPROPERTV�SHOWNflELOWORATTPf.HTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOF.S NOT PRESUME TO GIVE <br /> �or BLOCK or AUTHORI7Y TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STAi f:OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOf1MAP;CE OF CONSTRUCTION.THAT I AM AUTHORIZED OY THE <br /> OWNER O( THIS PROPERTY TO PERFUaM TIi[ WOqK FOR WHICH <br /> APPL�CATION IS MADE AND I COMPLV WITH THE SfATE <br /> PARCELTA%I.U.NUMBER CONTRACTORS LAW 10.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION�OAN LENDEP,AppRE55.1clEPHONe NUM3ER X/���—� /M'ff_ // /�) ^.) <br /> <-C ]L[ , •^ / 4 <br /> SIGNA URE � U ont1�-- <br /> ' /�-�/7�//� <br /> CITV BVSINESS UCENSL N0. <br /> ( PLUMBIN MECHANICAL <br /> � <br /> TYPE OF FIxTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATERCLOSET(TOILET) � q/C—A/HNDLGUNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> IAVATORY(WASH�ASIN) � HEAT PUMP , <br /> SHUWEq � UNI?HEATERS—B.T.U. M <br /> KITCI'.EN SINK 8 DISP i CLOTHES ORYERS <br /> DISHIM1'ASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ' RANGE HUOD � <br /> � <br /> CLOTHES WASHER ;— WATER HEATER , <br /> URINAL WOOD STOVE <br /> DFil�71(ING FOUNTAIN i MCTAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN FIREPLACE INSERT(WOOD BURNING) � <br /> 9ACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERVICE—BAR.ETC.) GAS RF�NGE <br /> � .l GHS PIPING � <br /> ' � <br /> � El(HAUST FAN ; <br /> � , <br /> � , <br /> SUF3 TOTAL S ? ; SUB TOTAL 5 ' <br /> � <br /> _ PERMIT $ Qi PERMiT S i <br /> TOTALFEE $ � TOTALFEE 5 � <br /> FOR OFPICE USE ONLY: <br /> FRONTSETpACK REApSETBACH SIpESETBPCK PLANCIIECNNlIN9FR FEF RECEIPTNO. <br /> usezoNe LOiAREA VACANISIiE FEES VAWATION FEE <br /> IIYES fiIJO —T— <br /> — OUILDWG � <br /> i <br /> IIEIGHTIIMIiATION NO.OFOWELLING SIZEC'pIUGRI — <br /> UNIIS <br /> P W MpING <br /> i <br /> OCCUPANCY NOOiS�ORICS C":LUPANiLOAU HASEMENT �— <br /> GROUP M[CHRNICFL i <br /> � <br /> IIYES I1 NO - - <br /> FIfiEALARMPEOU :�;q5p'1 AOpi110N�LPLANGH[CN <br /> �— _ <br /> OTIiER <br /> FIRF SPRINKLER RFO'D Pf.�SON _ <br /> ST�TE DUILDWG SURCH�qGE <br /> i <br /> rvPeoFr,or+sr ainNsarvnoveonr CITYOFEVERE7T runur.wonHs <br /> LOCAL SALES --- —�—�— <br /> onte TAX CODE IS 3105 TO7AL <br />