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APPLICATIOrI FOR CO�ISTRUCTrdN PERMiIT <br /> CITY OF EVERETT• BUILDING DIVISION �i� <br /> 3200 CEDAR STREET• E`JERETT, WA 98201 •259-8810 � <br /> rl DEMOLITION � 1 COMBINATION I � BUILDING •�ECHANICAL ' PLUAABING f 1 SIGN <br /> PROJECT ADDRESS <br /> � ��Y ' /� V£. <br /> owHEn ua�iaoonF�:ss c�rv a�r <br /> L /�� , r�wme <br /> ��C's�� /B�'.S /-/ov;' E' vc2t :r 98zo� 2S"9-.379Si <br /> iENANT IAMLA�ORL55 CITY ZIP <br /> P��ONE <br /> PRCNITEC70PDESIGNEp MRIIADORE:iS LITY ]iP PIIONF <br /> GENERAtCONRlA�10(i NRILADDf1E55 ��ry Z�� <br /> PIIONf GIATELICCNSE� <br /> MECHrtNICA��ONTRnCTOR MRIlADD9E55 ��ry ���, <br /> � � _ n PIIONE SiqTE UCFNSE� <br /> G� <br /> PLl1A1gR1GCON7Raf,TOR MRILADUR[55 CIiY ZIP PHONE <br /> $TFiE LICFNS[� <br /> GONfPAG i PqICE Of WORN <br /> 3Z S, �� HEA7ING SYSTEM: f.yG�AS � I ELECTRIC I 1 <br /> OESCRIBF.WpRN RNO SOU/RE FOpTIGE IkVOIVED COt1iqCT PFRSON AN�PNONE NO <br /> E� f�10S E,2 c�S j- ,�7 :' S� <br /> I IiEREBY CERTIFY THAT I HAVE READ AND ExAMINEO THIS <br /> PR�O-I.+�OSCD USE OF BUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> �C fS, PROVISIONS UF LAWS AND ORDINANCES GOVERNINC;THIS TYPE OF <br /> LEGALDESLRIPi1pNOFPqOPERTY(SHOWNBELOV/OqATiAGNIWOGOPI[51 WORK WILL BE COMPLIEO WITH WHETHER SPEGFIED HEFEIN OR <br /> NOT. THE GRANTING OF A PEFiM1T DOES NOT PRESi1ME TO GIVE <br /> ��T eL�K or_ AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL�pW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTP,UCTION,THAT I AM AUTHORIZED �Y THE <br /> OWNER OF THIS PROPEf71'Y TO PERFORM THE WORK FOF WHICH <br /> APPLICATION IS M��E HNO I COMPLY WITH THE STATE <br /> PARCEL TiVt I D NUMBER CONTRACTORS lAW 1Q.2?hCW AND 296.220 WAC, <br /> CONSTR;.,TIONIOANL[NpER.ADDRESS.TELEP110NE NUMBEP <br /> x �— G-Z8-9G <br /> _ SIf,NA RE � � . (/ DAiE <br /> C17V BVSMG55 LICF:VSC 1!0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EpUIPMENT FEE <br /> _ WATERCLOSET(TOILET) � A/C—A/HNDLfUNITS—H.P. —�— <br /> BATHTUB ' FORCED AIR S1'STEMS—B.T.U. M E.A. <br /> � � <br /> LAVATORY(WASH BASIN) i HEAT PUMP <br /> SHOWER � UNITHEATERS—�.T.U. M � <br /> KITCHEN SINK 8 DISP ' CIOTHES DRYERS � <br /> DISHWASHER VENTILATION FAN � <br /> LAUNDRY TRAY ' RANGE HOOD � <br /> ' CLOTHES WASHER i WATER HEATER —r— <br /> URINAL WOOD STOVE <br /> DRINKING FOUN7AIN AIETAL FIREPLAC�(WOOD BURNING) ' <br /> FLOUR DRAIN FIREPLACE WSERT(WOOb BURNING) i <br /> BACKFLOW PREVENTERS ; GAS FIRBPLqCE � <br /> � <br /> SINK(SERVICE—BAR, cTC.) GAS RANGE � <br /> GAS PIPING <br /> i EXHAUST FAN � <br /> i <br /> SUBTOTAL 5 ' � ,p�; <br /> SII�TOTAL 3 <br /> PERMIT 5 � PEPMIT S <br /> TOTAL FEE $ � TOTAL FEE $ v o 0 <br /> FOH OFFICE USE ONLV: �, <br /> �RONTSFTPACN RFApSFTBRCN SIDES[TBRCR PIFNCIIECNNIRdOf� F[[ RcCFIPiNO <br /> �' a i <br /> use2oNr iorqqE� vnr,qN�sirF FE VALUATION FEE <br /> _ r i res ��. uu ouamNc � <br /> t1ElG11T UMI1AiIpN NO OF UWC.IIING $IIE Of BIIXi�I <br /> ❑NIIG — <br /> riun+oir�c j <br /> OCCVP�Ncr ry9 nrsinn�[5 OCCUnpNiloAu ea$EMENt - --- <br /> —�_ <br /> GfiOOP NfGUNICAI j <br /> �I\ES 11NO � <br /> FlqE FUpM RE9P PFA504 ' POpIIIpNM.PLqN 01ECK <br /> OrNER � — <br /> �iI�FSPqiNqFRPfOp RFRSON <br /> SNE BUIl01NG SURLIIAqGE <br /> ivrearcovcr rin�vsnrrnoven�v CITYOFEVF.RETT runncwonKs � <br /> LOCAI SALES ' <br /> iaie TAX CODE IS 3105 TOT>� � <br /> --- --- —1-- - <br />