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APPLICATIV�1 FOR CONSTRIiCI rON� �ERrM�� s <br /> CITY OF EVERETT• BUILDING DIVISIt7N �U(''f ? � � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 "-- - __.... <br /> rl D� . <br /> OLITI� fl COMBINATION fl BUILDING MECHANICAL rPt'� � ��(�RETj' 1"1 SIGN <br /> PROJECT ADDRESS �Pt. <br /> OWNER MAILRODRESS CITY ZIP PNO�IE <br /> �I � I.l I-ks mr�=, ?�?�� �, a �rnCl � . E�'�0(� �i�n�l�9`�.1�--y�K "� <br /> TENPNT M/.�l AOf)PFSS GiY llP i`HONE <br /> ARCHITF.CTOROESiGN[R MnI1.A�OPE55 Citt 71P PIIONE <br /> GCNER�LCONiR4CiOR MAILFODRE55 Cirv ZiP PHON[ STAiEUCCNSE� <br /> MECHANIC�LGONTR4CTOR MAILADp�F55 CITV ZIP PIIOR[ STAiEUCFN$E+ <br /> � �mr-1-h n-I-��c��.��1�_���C ��'�O �Je�P+V- q�o�l '��'7-�II <br /> PLUMBINGCONiRACiOR M DDRESS CIIY 21P PHONE ^ ��S��.LI�N$5o, /��� <br /> I✓ f�✓I i �I <br /> '�ONIf1ACT PRICE ORN <br /> } � HEATING SYSTEM: �QG�4S �l ELECTRIC f l <br /> DE�c IOE WOR��HD�RE FOOTAGE INVOLVED C NTAQ P[PSON�Np P�pNF NO - <br /> �� <br /> � <br /> .�;,`.�1 �.^ I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> r oro Eo usE F uiioiNc APPLICATION AN�KNOW THE SAME TO BE 7RUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGRL�ESGRIPTIONOFPROPERTV�SHOWNBEIOWORATTAGHTWOCOPIES) NOT. THE GRAN7ING OF A PEFMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCN or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STCSE OR IOCAL LAW PEGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED DY THE <br /> OWNER OF THIS F�ROPERTY TO PFRFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITI� THE STATE <br /> PARCELTA%I D.NI/MBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRUCTION IOAN LENOER.PDDRESS.TELEPNONE NUMBER � ,��1�� , 1 � J (ij I��'Q� <br /> �SR�AYRE D i[ <br /> CITY DUSINE55 LICENS[NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATERC.OSET(TOILET) � A/C—A/HNDLGUNITS—H.P. � <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.U{ E.A. � <br /> LAVATORY(WASH eASIN) HEAT PUMP i <br /> SHOWER ' UNIT HEATERS—B.T.U. M <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS <br /> DISHWASHER � VENTILATION FAN <br /> LAUNDRY TRAY RANGE HOOD i <br /> CLOTHES WASHER � WATER HEATER <br /> URINAL WOOD STOVE ' <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WO00 BURNING) _�_ <br /> BACKFLOW PREVENTERS GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE <br /> GAS PIPING � <br /> — <br /> EXHAUSTFAN � <br /> i <br /> i <br /> SUB TOTAL 3 � SUB TOTAL 5 <br /> PERMIT 5 PERMIT S <br /> TOTALFEE $ TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> fiiONT SFTPACK PFAR SFTOACN SIpE SETPRCN Pt4NC11ECN NIIMOfP �E[ RFCEIPT NO <br /> �~ ��' <br /> uSeZONe iormvEn vnCnHrsire FEES VALUATION FEE <br /> — �IYES If NO OIOIDING � <br /> i <br /> HEIG�R IIMIiAT10N NO OF Oe:'eLtINC SIZE OP OIDCi�il <br /> UNIfS PLUMPING i <br /> OCCUPANCY NO Of S�OR'�B OCCUPANi IpAD PASEAIENT MECII�NICAL � <br /> GROUP � <br /> IIVES �'i ti0 — <br /> Flt1EAlA9MREO�D RFA50Y ff1�i110Nn1.t'IANG�[CK <br /> OiHER <br /> �If1F$PRINKLEqRF.O'D RFAFON -- ' <br /> STAIE OUIl01NG SI1RC114RCE <br /> r�rForr,oNsr rinrusnrvnovEnnv CITYOFFVERETT r���liif.wonKS I <br /> LOCALSALES - --------- '-- <br /> oA�E TAX CODE IS 3105 TO7A�__ _ _ _f_ _ __ �_ <br />