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�-. <br /> APPLICATII.N FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> Cl DEMOUTION Cl COMBINATION ❑ BUILDING ''y� MECHANICAL CI PLUMBING fl SIGN <br /> PROJECT ADDRESS ?O I J /e� �1�W(TT �V k � �F-����, °�'a`�O I <br /> OVMER MAILADd7E55 Cltt 21P PHONE <br /> M� A�.tr, �-?.l M3�I C�Ps� Av� Ev�t 44a�0� �►-3�7 <br /> r�r+ �oor�ss cin nP FHONE <br /> A ITECT Q51t��M111LADIXiE55 Gltt 21P PNONE <br /> GENERALC.ONTRACTIXi M�iIADDRE55 C1TV 2�� PHONF ST�TEIICENSE� <br /> MD_C�A�NORkS 790�1 INI�DE P.�. AR1Jt�bTO?� � �y35�121 Mi�b4SV�lddol�AA <br /> MECH�MG�LCONTRACiOR M�ILADORE55 CITY ZIP PHONE ST�TELICENSE� <br /> PLl1MEMOCONTi1ACTqi M�ILAODRESS Cltt ZIP PHONE STIITEUCENSE� <br /> CONTRACT PRICE OF WORK <br /> �I��' HEATING SYSTEM: p1 GAS ❑ELECTRIC O <br /> OESCPoBE VIOIIK AND SOU�RE FOOTAGE IH�OLVEO CONTIICT PERSON ANO PMONE NO <br /> E I S VAI,u�S K��`� 9'b 11� <br /> I HEREBV CERTIPV THAT I HAVE READ AND EXAMINED THIS <br /> P���ST�a� APPLICATION AND KNOW THE SAME TO BE TAUE�ND CORRECT.ALL <br /> '�". PROVISIONS OF LAWS AND ORDINANCES 60VERNINO THIS TYPE OF � <br /> WORK WILL BE COMPLIED WI7H WHETMER SPECIFIED HEREIN OR <br /> LEO/�lOESpMPTION OF PROPERTV(SHOWN BELOW ORATT�CN TWO COPIES� NOT. THE ORANTINCi OF A PERMIT DOES NOT PRESUME TO QIVE <br /> �oT e�oCc oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW RE6UUITINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PR O PERFORM THE WORK FOR WHICH <br /> APPIIC ION A E A I COMPLV WITH THE 3TATE <br /> PMCEL�AIf I.D.M/MBER CONT(� R 1 27 R AND 288200 WAC. <br /> 1 <br /> CdiSipUCTION LONI LENOER.�Oq1E5S,TELEPIIONE MIMBER � iJ <br /> X <br /> SION OAiE <br /> CI U51 S ICE NO. <br /> PLUMBINO MECHANICAL <br /> N0. TYPE OF FlIITURE OR ITEM FEE NO. TYPE OF flIfTURE OR ITEM FEE <br /> WATER CL09ET(TOILET) � AIC—AMNDLO UNITS—H.P. � <br /> � BATHTUB � FORCEO AIR SVSTEMS—B.T.U. M E.A. ' <br /> UVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 6 DISP i CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RAN6E HOOD ; <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL � WOOD STOVE ' <br /> DRINKINQ FOUNTAIN i METAL FIREPLACE(WOOD BURNINO) i <br /> FLOOR DRAIN � FIREPLACE INSERT(VJOOD BURNINO) � <br /> BACKROW PREVENTERS ; OAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � OAS RANOE � <br /> ' OAS PIPINO ' <br /> i EXHAUSTFAN i <br /> � � � <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S '� <br /> PERMIT S � PERMIT S '� <br /> TOTAL FEE S ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACN RE�R SETB�CK SIDE SETB�CK PUN CNECK NUMBER FEE RECEIPT N0. <br /> USEIONE LOiAREA VAC�NTSITE FEES VALUATION FEE <br /> f1YE5 fl NO BUILDING ; <br /> HEI6HT IJMITATION NO OF DWEtUNG SIZE OF BIDGR.i. � <br /> UNITS PLUMBING i <br /> OC�PANCY NDOFS10111E5 OCCUPANTLO�U BASEMENT MECHRNIGIL <br /> ❑YES fl NO i <br /> FlREALAflMREO'D RE�SON �ODITON�LPLANCHECK i <br /> OTHER � <br /> FIRE SPNINKIER REO'D RERSON i <br /> STA1E BUIIDING SURCHRRGE i <br /> iYPEOFCONST PUNSAPPROVEDBV CRYOFEVERETT 7UBLICWORI(S � <br /> LOCAL SALES � <br /> oare TAX CODE IS 3105 TOTAL I <br />