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APPLICATIt,.� FOFt C�ONS'TFiUCT cON B T <br /> CITY OF EVERETT^ BUILDING DIVISION 'I�I O <br /> �� nU 3200 CEDAR STREET• EVERETT, WA 98201 • 259•8810 �Y <br /> �cl l�1 jq � <br /> (� DEMOLITION fl CQMBINATION f-I BUILDING � MECkANICAL <br /> r..1....P,LUMB NG�`� SIGN <br /> PROJECT ADDRESS <br /> � � Public EV ERETT..- <br /> VVor � <br /> OWNER MAqApORE55 iry 1 PNp ' <br /> ��.u_�m�� 3��-������,/`� 9�i�� <br /> T NANT MNI.AODRf55 CITY ZiP PNONE <br /> PRCHITf.CT OR UESIGNER MAII AO�RE55 Cltt ZIP PMONE <br /> GENERALCONTRAC70(i IAN�qpURE55 CIIV IIP PNONf SIATEIICGNSF� <br /> MECHANICALCONTPnGTOR MnILA�DRE55 CITV IiP PHONE SintEUCF.NSE� <br /> ��—���� i ��li� I,+�v� AgS#--ap—�erP{��.�cw�7-n�i—__�-e,�s,c__C�y�rra <br /> PLU EINGCONtR/f,t0 ' � AOD E55 �� '�T—� Cln' ZIP HpNE STAT[IICENSE� <br /> CONIMCTPPICEOfW RH <br /> � � � HEATING SYSTEM: I�(I GAS I� ELECTRIC �l <br /> OESCRI E WOPK ANU SOUARE FOOTFGE INVOLV�O i COYTACT P[RSON�ND PHON NO <br /> �n�lutl -��g -1—,,�,arnn���C1-4C���Q1�4(�_.�mi-1Th—��7=(�-L� <br /> � I HEREBY CERTIFY THAT I HAVE FEAD AND EXAMINED THIS <br /> PR ros usE o4g mon+c APPLICATION AND KNOW 7HE SAME TO BE TRUE AND CORRECT ALL <br /> j� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> --�� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALOESCPIPTIONOFPROPERtt�SHOWNBELOWORATTAGHTWOGOPIES) MOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT�_BLOCK ov �'1'P �(PSP��� AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> O�rHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> _ PERFORMANCE OF CONSTNUCTION.THAT I AM AUTHORIZED BY THE <br /> ON'NER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APFLICATION IS MADE AMD I COMPLY WITH THE STATE <br /> PARCEI.70.k ID.NOMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTIONIOANIEN�ER.ADDRE55.TELEPNONENOMOER �1V��1� � � I�Q/�I <br /> 9'ATUIiE DA (`/� r� <br /> CITY�USM[55 LICENSG NO <br /> PLUMBING MECHANIt:AL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYpE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—MHNDLG UNITS—H.P. <br /> BATHTUB � FOFCED AIR SYSTEMS—B.T.0 E.A. � <br /> LAVATOFY(WASH BASIN) � HE,�1 PUMP --�— <br /> SHOWER � � UNITF!EATERS—B.T.U. M <br /> KITCHEN SINK 8 DISP i CLOTHES DRVERS � <br /> DISHWASHER � VENTILATION FAN <br /> _ LAUNDRY TRAY ' qANGE HOOD <br /> CLOTHES WASHER � WATER HEATER <br /> URINAL � WOOD STOVE � <br /> ORINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GASFIREPLACE ' <br /> SINK(SERVICE—BAR, ETC.) GAS RANGE <br /> GAS PIPING � <br /> i <br /> _i <br /> EXfIAUST FAN i <br /> i � <br /> SUB TOTAL 5 SUB TOTAL 5 <br /> PERMIT 5 � PERMIT S <br /> TOTALFEE q TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> fpONTSFTPACK RFRPSF.T�ACN SIDES[IDALK PL�NCHECKNUMfiffi f[F t1PCFIPiNO <br /> usezone �otanEn var.nNrsire FEES VALUATION FEE <br /> fiYE$ 11 NO �- <br /> p1111DiN6 i <br /> NEIGIIII'MITATiON y00PDWF.LLiNG SIZEOFy�p(;/il i <br /> IINIIG <br /> PIUN.�ING <br /> OCCUPFNCY NO Oi5lpqiES pCCUPANiLO�U ppSEMENi � <br /> GROUP M[C��<NIC�L i <br /> i <br /> IIVF.S !1 NO - -� <br /> FlfIFALARHIqEO�D 11PASON ��DI110N4tPLANG�FCK <br /> __�-- <br /> O111Efi � <br /> �IRFSPFIkqERREO'p qf�SON <br /> Sil�lE�ViIDMG SIIRLIIAqGE j <br /> tvaeoFr,er�sr ninr�snrvnovronv CITYOFEVERETT rvm�nr,wo�Ks <br /> LOCAL SALES -- -- -- -- <br /> untt TAX CODE IS 3105 TOTAL <br /> � -- — --- ---�— <br />