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APPLi��AT�` 1� FOR CQPlS7F�UC IOM F�ERMIT/ <br /> CITY OF EVERETT• BUILDING DIVIS�ON {!C+��'� <br /> 3200 CEDAR STREET• EVERETT, WA 38207 •259-8810 �� <br /> ❑ DEMOLITION l�l COMBINATION �{ gUI�DING ❑ ;A.nECHANICAL I l PLUMBING (-I SIGN <br /> PROJEC7 ADDREiS � p�� � <br /> ;/�J��/ — ��k' G i"n �F' /-) V r . <br /> owNen rnni�anoness �i��� - <br /> r��oNe <br /> _�h'l�-L%� I-lav,���- ` �;l '- -F l, i - i�� �r � r1/ ��t „ � . . � o <br /> TFNAYT �AAILApORC55 CITY ZIP PIIONE <br /> ARLIIITECTOIl0E51GNEfl Mn.LAUpRE55 CIiY ZIP PHONE <br /> GENEf1ALCONiB�CTOR r•41LADOf1E5S CIiI ]IP PIIONE Si<i[LICFNSE� <br /> `,r?�a,F /� � ✓.o�c.�,'L i��q��_y �fi �:.01 -1 <br /> MECH�NICALWNiltACTOR MN�AOURESS CITY 21P PIIONE SiATELICEN5E1 <br /> FLUMBINGCONIFIACTOR MAILA7URE55 CITV ZIP PHONE S7�iELICENSEY <br /> CONIfiACT PqICE OP WOf1K <br /> HEATING SYSTEM: �(GAS ❑ ELECTRIC ❑ <br /> �ESCfilOE WORK ANp S'OU/FIlE FOOiAGE INVOLVED �^ CON7ACT PEliSON�ND PIIONE NO. <br /> � - /d / �JDi� �.Jrl`ll � <br /> � � C7 1 0��1 Y�- �c. f� i�i ✓h.�_, <br /> / ) .� �� `� � C 7� .�; S'- S 7 O cc r 7 2/'4� <br /> a � p �' �?t��,.t����Q I HERE�Y CERTIFY THAT I HAVE READ AND EXAMINED TH;S <br /> PFGPOSEUUSE OF�UII.UING ` � -- APPLICATION AND KIJOW TI1E SAME TO BE TRUE AND CORRECT.ALL <br /> FROVISIONS OF LAWF ANp OHDINANCES GOVERNING THIS TYPE OF <br /> ��u���� ��"M" �� �J" `'� �"'^� ' � WORK WILL BE COntPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEOALDESC'R/IPTIONOFPROPE"IY�SHOWNOELOWORATfACNTWOCOPIES� � NOT. THE GRANTING OF A FERMIi COES NOT PRESUME TO GIVE <br /> �oT�o�oc% .�F �� ���`� {��wk c�j AUTHORITY TO VIOLA.f[ OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR �OCAL L"nW REGULATING CONSTRUCTIO�F 7R THE <br /> !?t��T %ir�E'K PENFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZEC� BY THE <br /> OWNER OF THIS PROPERTY TO f'ERFORM THE WORK FOFi \NHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> rnncE�rnx i.o.r:u�,+sEa — CONTRACTORS LA�N 1827 RCW AND 29G..^.00 WAC. <br /> _ �C,l � - oOc�- C [,� ) <br /> C0�I5!fiJCTION LOAN LENDER,A00(1E55,iELEPHONE NUMOER x_/ }-.�� .r../�,�/y / _ L L7 _ �J-- <br /> - SIGNATIIfjE OA�E <br /> CITY OUSINESS UCENS[N0. <br /> PlUMB1�IG MECHANICAL � <br /> NO. _ TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FI%TURE OR fTEfv1 FEE <br /> WATER CLOSET(TOILET) —i A/C-A/HNDLG UNITS-li.P. �- <br /> OATHTUB ; FORCED AIR SYSTEMS- B.T.U. M E.A. � <br /> ` LAVATORY(WASH BASIN) � HEAT PUPAP �- <br /> SHOWER � UNITHEATERS-AT.U. M � <br /> KRCHEN SINK d�.DISP i CLOTHES DRYEP.S � <br /> DISNWASHER � VENTILATION FAN i <br /> LAUtJDR"TRAY ' RAh� e HOOD � <br /> � � <br /> CLOTHES WASHER � WA'EH HEATER � <br /> UPIDtAL � WOOD STOVE � <br /> CRINICING FOUNTAIN i A7ETAL FIRFP�CE(WOGD t3JRNING) � <br /> _ FLOOR DRAIN � FIREPLACE IN^ERT(WOOD CiURNING) � <br /> _ BACKFLOW PREVENTERS ; GASFIREPLACE � <br /> SINK(SERVICE-BAN,ETC.) � GAS RANGE <br /> -�i--- <br /> _ ; GAS PIPING � <br /> i EXHAUSTFAN � <br /> — _�_ <br /> � <br /> i - - � <br /> - � <br /> T <br /> 1 � <br /> � ��- <br /> SUB TOTAL $ � SUO TOT,4L S � <br /> �� PERMIT $ _ i _ PERMIT S �T <br /> TOTrlL F£E $ � TOTAL FEE g —�— <br /> FOfl OFFICE USE ONLY: <br /> Ff10NTSFT[i�CK / P'c�q5+�ET0�CN� SIDESE} CK PIANCIIELKNUM�EO FEE� OECFIPTNO. <br /> GC% _ ( � ,5i � l - . <br /> us[zoNe��+ iornqen��L � �vncn�rsrte /�F[ES VALUATION FEE <br /> _ � u J nves n No om�oiNc /J <br /> IIEIGNi LIMITATION/ NO.OF U'NELL/NG 51[L OF pLDGII I. - <br /> O � _!Z! � '�� <br /> UNIi$ I7%C SL L1Vb„�(., pWh1U1NG --i- <br /> - Sp GnaA� <br /> occurnricr ��o.ovsiomes occuvnNr�ono nnseMeHr -- � <br /> GBUUP MECH4NICAl y <br /> R3 Z /� r,res � ;—_ <br /> rir�en�nnrrneo�o n�nsot� AU�IiIONALPl6NCIlECR � <br /> g � <br /> omrn ; <br /> Fine sr r.�Niu.en nEo�o — nensoN � <br /> srnTe ouuoiNc suncnnnce � <br /> ;r� <br /> TYPEOFCON3T rv,Nsnrrno I�ov CITY OF EVERET7' vuoucwonns <br /> ,t LOCAL SA!ES ��� '� ''_.' <br /> SL�IJ or.te Fj LG i 5 TAX CODE IS 3105 TOTAL I <br />