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APPLICATIGr�I FOR COIdSTRI�CT ON PERIVIIT <br />CITY OF EVERETT • BIiILDING DIVISION <br />3200 CEDl,R STREET • EVE.AETT, WA 98201 • 7_59-8810 <br />fl DEMOLITION f 1 COMBINATION f � BUILDING �6 MECHANICAL � I PLUMBING f 1 SIGN <br />PROJECT ADDRESS ' <br />OWNER MPiLA00RE55 <br />GF.NEf1PLCOv�Hnciu�� M�a�rwu,n:o� <br />MECHANICAlW1:TRnCiOR MfIIADORESS <br />; 4 f.���. <br />PWMBING ONIRPf,TOR MAIL4�URESS <br />CONiRACi PRICE OF WOnN <br />sf voa . "' <br />D[SC(ilOf WORK �Np SOU�RE FOO'IRGE INVOLVED <br />LEGAL DESCPoFTION OF FROPERtt ISMOWN BELOW <br />LOT BLOCK Of_ <br />f,IIY <br />�_lIf (i� <br />❑TY <br />CI�Y <br />Gtt <br />J/� ��T Ki'�,E <br />f,liY <br />_ �i�� T � .lrr/c <br />PARCEITAXIA.NUM�ER <br />CONSTRUCTION LOPN L[NOER. �ODRE55, TEL[PHONE NUM�F:R <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY �rVA7H BASIN) <br />SHOWER <br />KITCHEN SINK 8 UISP <br />DISHWASH[R <br />LAUNCRYTRAV <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL 5 <br />PERMlT 5 <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />fRONTS[TARCK RE�RSF.TMCN <br />OSEZON[ IOIAREA <br />H[IGIIT LIMITATION NO Of UWFLIING <br />❑NtLS <br />(Nl('IIPANCV HO 01 SfDR95 OCCUPANI LOAO <br />FinF <br />iveon <br />orroNci r�nrv9Mr�oovEn <br />rni� <br />:ir r��o•�e <br />]IP CnONE <br />]m rlloNF. <br />nn PIIpNL <br />71P PIIONF. <br />98o3y Szo- <br />ZIP PHONE <br />S�At[ f IC[NSE � <br />STnTE LICf:NSE e <br />C . O ��S' /' y-. <br />STATF. LICFNSE � <br />HEATING SYSTEM: I 1 GAS � l ELECTRIC p(1 <br />coNrnctP[nSONnnDrrloNFNo. �% � <br />o –� a <br />I HEREBY CERTIFY THAT I H�VE READ AND E%AMINED THIS <br />APPLIGATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS ANC ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILI BE GOMPLIED WITH WHFTHER SPECIFIED HEREIN OFl <br />NOi. THE GRANTING OF A PERMIT D�ES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTFUCTION OF THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORRE'7 BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE N'ORK FOR WHICH <br />APP�ICATION IS MADE AND I COMPLY WITH TI1E STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />� r� �9� <br />SIGNA FiE , � �Aj' <br />f.ITY I1115MF55 LICF.NSC NO. <br />FEE NO. TYPE OF E�UIPMENT _ <br />� A/C—A/HNDLGUNITS—H.P. <br />� FORCED AIR SYSTEAIS — B.T.U. M E.A. <br />HEAT PUMP <br />—� UNIT HEATERS — B.T.U. M <br />� CLOTHES DRYERS _ <br />i VENTILATION FAN <br />� RANGEHOOD <br />—r WATER HEATER <br />� WOOD STOVE <br />METALFIREPLACE IWOOD BURNING) <br />FIREPLACB lNSEFT (WOOD BUR�iING) <br />; GAS FIREFLP�E __ <br />GAS RA�iGE <br />� GAS PIYING <br />. � E%HO,UST FAN <br />SIDESETP4CK PLANC��[CHNUMOFR <br />vncnrvrctte FEES <br />I IVES I'� NO p1I1101NC <br />SIZE Of plDG4� <br />{'I UMOING <br />HASEMENL MfG�4NICN. <br />IIVES I1 NO <br />ADpI110NnL PI RN G�F.CM <br />on�rn <br />rme ouiton+a sunr,��nnc,c <br />—�Y OF EVERETT 1 � ������ �� �"n"^° <br />� <br />T <br />S:IB TOTAL $ � _ <br />PERMIT 3 r <br />TOTAL FEE $ <br />rrr- nei-rirrNo <br />LOCALSALES ---�- ---� <br />TAX CODE IS 3105 TOTA� ___ _ _ ___ <br />