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APPLICATIOrI FOi3 CONSTRUCT.ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION fl COMBINATION fl BUILDING MECHANICAL f l PLUMBING fl SIGN <br /> PROJECT ADDRESS <br /> �. �H � �1 E�t <br /> OVYNEP MAIL�ODRESS CITY Zm pHONE <br /> _Nt�o�� P4a�rc '150� N�a�.�R Wa4 �ve���� �s�ao', (ac�1353-8oS3 <br /> TEN�NI MAILRODRESS CITY TIP CIIONE <br /> S�u�F_ <br /> ARCHRF.LTOR�ES�GNER MRII.ADORE55 CITY 71P PHONt <br /> GENEBPLCONiR�CiOR MAILADORE55 CItY ZiP PHONE STqTE11L[NSE� <br /> MECHRNICALCCNiRACTOR MPqADDRE55 CITY ZI{' p110NE STATEUCF.NSE� <br /> 1� �1 <br /> PWM6INGCONTRRCTOR MAILAODRESS CRY ZIP PHpNE STRTELICENSE� <br /> CONT�T PqICE OF WORN <br /> \ HEATING SYSTEM: I GAS f l ELECTRIC I l <br /> DESCRIBE WORN AN�SOUARE f00TAGE INVOIVED CONTACT PERSONANO PHONE N0. <br /> �Q tJ�1.s0� <br /> zA1STPll 6A5 FU6ZNAC�. �`l� — �315 <br /> =�,S'j�L �� �W; I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> FROPoSEDUSE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND C .'RECT.ALl <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING TI;iS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SP£CIFIED HEREIN OR <br /> LEGALDESCRIPTIONOFPRpPERTY�5H0YMBELOW0i1ATTAGMTWOCOPIES) N07. THE GRANTING OF A PERMIT DOES NO7 PRESUME TO GIVE <br /> �or eiocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAI.LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PARCEL TAX I.D.NUMBER� CONTRA�CjTORS LAW 182/7�HCW AND 296.200 WAC. <br /> CONSTRUCTIDN LOpN LENOER.ADDRE55.TELEPY.011E NUMBEH` x UC � V/ V�n � �� � '� �. Lt� <br /> SIGNr1TU E� L�'9Fb DATE <br /> CITV 9USINESS LICENSE NO. <br /> I�LUM8ING MECHANICAL � <br /> NO. TYPE OF I-IIRURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET(T�OILET) � A/C—A/HNDLGUNfTS—H.P. � <br /> BATHTUB � FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH 5ASIN) � HEAT PUMP , <br /> SHOWER � UNITHEATERS—B.T.U. M <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYEFS ; <br /> DISHWASHER VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL WOOD STOVE � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) �L— <br /> FLOOH DRAIN � FIREPLACE INSEFT(WOOD BURNING) � <br /> BACKFLOW PHEVENTERS ' GAS FIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE � <br /> ' GAS PIPING � <br /> i EXHAUST FAN i <br /> � , <br /> � , <br /> SUB TOTAL $ � SUB TOTAL $ ' <br /> PERMIT $ i PERMIT $ � <br /> _ TOTAL FEE $ � TOTAL FEE $ � <br /> FOR OFFICE USE ONLV: <br /> FPONT SFTPACN REAR SFiBACN SIDE SETBnCN PIAN CIIECN N�IIM/g,F,p FG[ qECFIPi I10. <br /> y'� <br /> usezOwe i.ornqen vnenr+rSitE FEES VALUATION FEE <br /> i i ves �� No awimr+c I <br /> � <br /> IIEIGNiLIMITFTION NOOFOWELIING S12EOFBlDfi.Rl i <br /> 11NITS <br /> PWMpING <br /> OCGUPANCI NOO�SInqIES OCCUPANiL04D BASEMENi MFC11nNICaL ~ <br /> GBOUP <br /> f1YE5 il NO � - <br /> i <br /> FIREAIARMREO'[1 RF:ASON <br /> AppIIIONM.PI AN GIF.GK � <br /> �_�_— <br /> O111FR � <br /> FlBF.SPRINKLF.R REO'D RFAS(Nl <br /> STNE OURpINC SUlICIIAlIGE � <br /> �_� <br /> rmeonroNsr rinwsnrrnovFnov C�TYOFEVERETT rumir.wonres <br /> LOCALSALES — <br /> „q,E TAX CODE IS 3105 io7a� <br />