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APPLICATIOiV FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT • BUILDING DIVISION ;;1 r'r• � ,; , <br /> 3200 CEDAR STRECT• EVERETT, WA 98201 •259-8810 ... ��'' ��%, , <br /> q5-�UI � / cir ._ ...... . ... <br /> fl UEMOLITION ( 1 COMBINATION I l BUILDING fd MECHANICAL i , �L�19111t�a�?�T""'F•a SIGN <br /> PROJECTADDRESS " ^�risDept. <br /> !` , <br /> OWNER MAILAO�RF55 CItV 21P PIION[ <br /> NtmP� <br /> tENANT MAII.ApDRF55 .... ]IP pHONE <br /> ARCFITfCi0R0E51GNER MAlIA00RE55 �ITY )IP PIIONF <br /> f.F.NEA�L CONiMCtOR MAILAODRE55 CI1Y ZiP f110Nf $iATE lIC[NSE� <br /> 5M i-t� Nc'`�Ri,RR <br /> MECHANICAI CONiR4CTOii MAIL AO�FESS Cltt ].R` PIIONE 5 �iF LIC.NSE� <br /> �� j-1-i�1 �C',,�1'KtcL nc,�ifl<< ^� �--���--H1�1�=�-�'�d�_1�C�el�- q��(?"1 �r7-C2 �.,Z I <br /> PLUMBINGCONTPaCTOR MMLApDRE55 wT� Cli\' ZIP PNONE STNELICENSE• <br /> CONTRACi PqICE Of WORH <br /> HEATING SVSTEM: I✓GAS f� ELECTRIC f l <br /> DESCFI9E WORK RND SOUARE FOOTAGE IN OWEU CONLACT PERSON 4N0 FI� NE NO <br /> � � <br /> �wr��k ._, � f,c�u d,'a a��' <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW TFIE SAME TO BF TRUE AND COFiRECT ALL <br /> rr�oro .ouse` unIoiN� 1 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> _rC��J t�+P(�'�{� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREiN OR <br /> LEGAl�ESCPIPTIONOFPROPERTY�5110WNBELOWOPRifAC11TWOCOPIES) NOT. THE GRANTWG OF A PERMIT DOES NGT PRESUME TO GIVE <br /> ioT �_e�ocK or AUTHORITY TO VIOLATE OR CA�CEL THE PROVISION OF ANY <br /> -(he { reserv �THER STATE OR LOC�L LAW REGULATING CONSTRUCTION OR THE <br /> ��f'P 7Q� :� � PEFFORMANCE OF COMSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> ����C� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br /> PAqCEI TA%iD.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> COYSTpOCT10N LOAN LENDER.1D�fiE55.TELEPMONE NOMBER �, ,��f� � <br /> 5���.,��L�3 Ra".���--'� <br /> CITV BUSINESS l ICENSE N0. <br /> PLUMBING MECHANICAI <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. iYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A/HNOLG UNITS—H.P. <br /> BATHTUB � FORCED AIR SYSTEMS—�B.T.0 E.A. <br /> LAVATORY(WASH BASIN) ' 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 <br /> URINAL WOOD STOVE <br /> DRINKING FOUNTAIN METAL FIflE{�LACE(WOOD BURNING) i <br /> FLOOR DRAIN FIflEPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS i GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) GAS RAN6E <br /> � GAS PIPING � <br /> — <br /> i EXHAUSTFAN � <br /> i <br /> SUB TOTAL S SUB TOTAL 5 <br /> PERMIT 5 PERMIT 5 <br /> TOTALFEE $ TOTALFEE S ( <br /> FOR OFFICE USE ONLY: <br /> fPOVT5FTt1ACK PF:AliSF.TPACN SIpES[TBlCK PIANO�[LNNUMOFR �[[ RFCFIPiNO <br /> 7 � <br /> y_�� <br /> usezoNr: �ornnEn vncnNrsire FEES VALUATION FEE <br /> fiYES II NO 01➢LDING � <br /> — i <br /> IIEIGIITLIlAITATION NOOFUWELUNG 512EOPBlOG41 <br /> UNI15 PLIIM1!ItING � <br /> T <br /> OCCUPFNCv Np Oi510FiE5 OCCUPRNilOAD BASEMENi MECIInN�CAt � <br /> cnour <br /> IIVES II NO — - -"- <br /> fIRFPL��MREOT �PASON ROOI110NAI.PIANGiF.CN <br /> ��_ <br /> OiHER <br /> fIR.'cppRlNIF.RRF:QO RF�SON — <br /> STNG f1UIlDING SIlOC11AliGE <br /> irrForr,or+si vtnHsnrrnovenov GTYOFEVERETT ruour.wonrcs <br /> LOCALSALES -- - — <br /> ��qiE TAX CODE IS 31G5 TOTAL <br />