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APPLICATIO.� FOR CONSTRUCT. JN PERMIT <br /> CITY OF EVERETT•(3UILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> O DEMOLITION �COMBINATION O BUiLDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: � I a� / y,�/�'3�g'n ��� <br /> o�En��� ��•MMLAODRE"-"'s�'^Rr?R.� /�J�RE� Y'�7A / o`�.s.�'��-Da`L _ <br /> �--- <br /> TENANT MMIADORE55 CITY ZiP P��ONE <br /> Cr-v a; ,�✓F,��-�-r c-�-ri P —�- <br /> ARCMI�ECT OR U S�GNER M�II�DDRE55 GTY ]IP PIIONE <br /> �hss. t-1-�� t`��iL�FiPStf70B'� �litc� ��✓E�� y'8'Z6� s?S.?3377 Vl5S�B333-s`/J� <br /> GENEflAICONTMGiOR MeIL��ORE55 CIIY 71P PI10NC SIRIEIICFNSE� <br /> MECH�NIC�LCONTRACTOR MAIIRODi1E55 Cltt I�P GP��ONE/ ST�TELICENSE• <br /> �F-'S"/[�'vG TW��U ��07 6G1A�7 !2aILRD A�[,I�L �4..�--1-0 �_J'� � !�"�o I r i� C(��AI�P'X"Q-.'L'7�� <br /> PWVuiNGC0��111AClOfI MAIUDDRESS Gtt ZIP PHONE STATEUCCNSE• <br /> ac. .et1� <br /> Cq�TRACT PRICE OF WpI1K HEATING SYS7EM: ❑GAS ❑ ELECTRIC ❑ <br /> b�er �e u-;l 6 ! �r <br /> D SCR�6E FN�ND SOU E F TAGE INVOI.VED CO'IT�:.T VEfiSON�ND P110NE NO <br /> -F� `I— c.l� I���a � r+�/� 259—/ - <br /> 4 � � '/ <br /> � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROPOSEDUSF OF BI11l�ING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> '.EG�LDESCRIPTIONOFPROPERttI5110WNBELOWORATI�CNTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUMt TO GIVE <br /> ioT etocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERfORMANCE OF CONSTRUCTION.THAT i AM AUTHOFIZED BY THE <br /> — OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION I MAD ND I COIAPLY WITH THE SfATE <br /> CONTRA TORS 1B. 7 R W AND 296.200 WAC. <br /> PMCELTA%10 MBE /frJ��� �/ <br /> �3�/'%3�-�-'G � <br /> CONSTRUCTION IOAN LENCFR.AU�RESS.TELEPNONE NUMBE� �( <br /> SIGNATU DAT[ <br /> CIiY 6USINE55lICC^.SG NO. <br /> PLUMBING MECHANICRL <br /> NO. TYPE OF FIXTURE OR ITEM FEE TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNRS <br /> ' BATHTUB ' ORCED AIR SYSTEMS � <br /> LAYATORY(WASH BASIN) � H T PUMP ' <br /> SHOWEfl � UNI EATERS � <br /> KITCHEN SINK 8 DISP � CLOTH DrIYERS � <br /> DISHWASHER � RANGE H D � <br /> LAUNDRY TRAY ; WATER HEAT � <br /> CLOTHES WASHER � WOODSTOV[ ' <br /> URINAL ' MEfAL FIREPLACE OOD BURN ) ' _ <br /> DRINKING FOUNTAIN � FIREPLACE INSERT(W OD 8 NING) � <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFIOW PfiEVENTERS ; GAS RANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING <br /> EXHAUST FA <br /> i <br /> � <br /> i <br /> i <br /> � <br /> i � <br /> SUB TOTAL $ ' SUB TOTIIL S ' _ <br /> PERMIT 5 � PERMIT S � <br /> TOTALFEE $ ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: ry <br /> fPONTSETOALN AEp�iSF.TBACR SIOESETP�CH <br /> rur+ci\./�'� �� rec ner.Emt r+o <br /> L <br /> FEE VALUATION FEE <br /> USEI(N1E IOT�REA WUNfS11E � <br /> ❑YES ❑ NO OUILDING �jQL7`� � � <br /> HE�GIR LIMIT�TION NO O�DWELLING 512E OF BLDGrtI /� � ! <br /> UN17S � P�IIMOING / `'i_T_ <br /> �� � i <br /> OCCUPANCY NO O�S�L�ES OCCUPFNIIOAC BASEMENT �� MECMnNILAL � _ <br /> G�qnOU� ❑YES 1Y�7 <br /> 1�"3 -- 4DDI f IONRI.PUN C��lCN <br /> FIRESPRINKLERPEO'D �FASON --�—' <br /> i <br /> OIHER � <br /> � <br /> FIflEAIARMREO'D AE�SOrv ./ �/j <br /> ' STAIE011RDINGSIIRCMARGE '� �/ <br /> TYPEOFf7N$T �'l�N$RPPOqVEpBv CITYOFEVERETT ruonr,wonKs __ _ <br /> Ue7 LOCALSALES <br /> oaiE � TAX CODE IS 3105 7UTAL _ <br />