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APPLI�ATIv��i FOR CnNSTRUCT r01�1 PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR uTREET• EVEREI?, WA 98201 •259-8870 <br /> fl DEMOLITION �l COMBINATIOPC 1'f BUILDING I 1 MECHANICAL � 1 PLUMBING �l SIGN <br /> PROJECT ADDRESS <br /> o� MnI�qDDRE55 cm zir ri�or+e <br /> lr(Z2�-; I 1,�2 7Lt-i 'i � �7�l�r � i��Sc�,n �i2 t��7(,�,bQ- �� <br /> IENANT IAAIIApORf.55 CITY ZiP PHONE /� <br /> ��/ /�LO�' <br /> pRCHITCCTORDE5IGNER MAILqpOPE55 CITV ,iP PHONE <br /> GF.NEPI.L CONTR�CIOR MAILAppRESS Clil" pip PIIO�iE GtAiE LICENSE� <br /> �(7mv� i <br /> MECHANICAL ONTqACTOR MAIInGCRE�., f.liV 71{' p110NF STATE LI�EivSh� <br /> PWM9INGCONiRAf,TOR MFItAppRESS CItY ZIP PHONE SiAtEI.ICFNSE� <br /> CONtqACT FRICE OF WORN <br /> HEATING SYSTEM: f 1 GAa rl ELECTRIC f 1 <br /> DESCRIBE WORK 4N0 SOU4RE FOOTAGE INVOLVED CONTACi PERSON AND PHONE NO <br /> I-A C.c S t�(�t,Q., �u✓� (,e%�6 <br /> 72��C� C«�ta�,=, �e UJ <br /> �7 S �oc � 1{ l'C'Cl�l�l� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> raoroseo us�oF am oir+c � ���5 � ��. APP��CATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> iecnio s FIPTIONOFPROPERN(SHOWNBEIOWORATTACNT\VOGOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot eiocK _or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULAfING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THI RO RT ERFORM THE WORK FOR WHICH <br /> AP LI MA AND COMPLY WITH THE STATE <br /> PARCEL TAX ID.NUMBEP CO ACTOR LAW 1 27 RC'W AND 296200 WAC. <br /> CONSTpUCPONLOANLENDER,AD�RESS.TF.LFPNONENOMFIER X <br /> � `1�l�'i �4'S <br /> SIGNRTp�E DATF <br /> CITVBIISINE55l . NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI7(TURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. L— <br /> LAVATORY(WASH BACIN) HEAT PUMP � <br /> SHOWER ' UNIT HEATERS— B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES DRVERS � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY � RANGE HOOD � <br /> CLOTHES WASHER WATER HEATER T— <br /> � <br /> URINAL WOOD STOVE <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WO00 BURNING) <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) <br /> BACKFLOW PREVENTERS GAS FIREPLACE � <br /> � <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE <br /> GAS PIPING <br /> i EXHAUS'FAN <br /> ' � <br /> ' � <br /> SUB TOTAL 5 SUB TOTAL S � <br /> PERMIT 5 i PERMIT 5 <br /> TOTAL FEE S TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> fPONTSFTPACN REMScTOACK SIOESEiBRLN P14NC11[CH�iUMpFP fEF RECFlPTNO <br /> usezoNe toranen vnear+rsire ��5� VALUATION FEE <br /> ��rEs �; No aw�nirvc ���Q l' ; — <br /> ��eic��r uMrtnnoN ra oF oweiunc sae or oiocrti <br /> UN�rg <br /> PLIIMOING <br /> OCCUPANCV NO M SIORIES IX:CUPAM l U OAtiEMENi , <br /> G�{� � .� M[GI�NICAL _— i — <br /> IIVES <br /> FI ALAPMREOD qFA50N � �DDi110NnI.PLANCHFCK <br /> —__�_— <br /> Oi11ER <br /> FlRF.SPRINNIERREO'D qF�SON _ <br /> SL41E pUIIDVlC SURf.H�Rf,E �, <br /> rrreor'r,oNsr rinNsnrrn �v CITYOFEVERETT runiicwonKs ' <br /> LOCAL SALES <br /> � o�iE �o/QS TAX CODE IS 3105 � TOTAL I (�j�r <br /> J � <br />