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�, � <br /> APPLICATIG.� FOR CON�TRUC?.JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION Cl COMBINATION f�l BUILDING MECHANICAL f7 PLUMBING fl SIGN <br /> PROJECT ADDRESS �O/ � � � <br /> - u2-- / f � <br /> pNmeq MAIL�OOilE55 crtv nr rnori¢��� -�3// <br /> l�z r2.�c �1�rft.�u.t S��.�- _ <br /> 7EN/�NT MAIL11DbRE55 CITY 21P PHONE <br /> ? <br /> MiCMTECTORDE5IGNER MAILAODRE55 LIiY 21P PMONE <br /> /j�/' �=NG-�.vr-i' 2�:/� i Y��/=- <br /> OENEMLCONTAACTOR M�ILADORE55 � GITY ZIP PNONE STATELICENSE• <br /> 3�5�--/ 3 3 r' <br /> MEpIN1IC�LCONi/RACiOR M/�ILADORE55 ,�CITY 21P tNONE o STATEIICENSE� <br /> /�G/l,^ /: T.� rres.i 5���'��s /� /jd� 7�T�Z i`i(iif-/«�T /o1U/ �ei�,Fl�#olr,�/ac <br /> PLUMlMOCON /�CTpR M�ILADDRE55 C!TY IIP PNONE STATEUCELNSEII <br /> T/IC'GGSR O(o(o <br /> CONiMCT WtlCE OF MqRN/. 7� HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ �G <br /> pE90q1lE Wa1N(I1ND Sq1ARE fWThGE INVOL CONTACT PERSON�NU PMONE NO. <br /> 1-c. �aoriO %r <br /> .�- u ti ��� c� �. <br /> V " ir/O S S /!n7 � HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> � G-�= APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �� ���p� PROVISIONS Of LAWS AND ORDINANCES GOVERNINO THIS TYPE OF � <br /> '� WORK WILL BE CAMPLIED WITH Nh1ETHER SPECIFIED HEREIN OR <br /> �aKp¢s�pnar�pFa�oreqrv�ywpwnee�owaa� �c OPIES� NpT. THE ORANTIN6 OF A PERMIT DOES NOT PRESUME TO OIVE <br /> im �� � AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW RE6ULATINO CONSTRUCTION OR TME <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE I COMPLY WITH THE STATE <br /> CONTRPCTORS UW 18.27 AND 296200 WAC. <br /> pMCEI TN(I.D.M1M9ER A <br /> CON91N11CTIOq LONI LENDER.�OdiE33.TElEP1/0NE NUMBER � A : " / ?i✓C�� S Z' <br /> SI6N RE �� ^/� l OATE <br /> X S <br /> CITV BUSINESS LICENSE N0. <br /> ��Q MECNApICAL <br /> NO. TIIPE OF Fl)(TURE OH ITEM FEE NO. TVPE OF FlKTURE OR ITEM �E <br /> � WATER CLOSET(TOILET) � A/C—M'iNDLG UNITS—H.P. ' <br /> ��UB � FORCEDAIRSYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> S��q � UNITHEATERS—B.T.U. M ' <br /> � <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> UIUNDRY TRAV ; RANOE HOOD i <br /> CLOTHES WASHER � WATER HEATER ' <br /> URINAL ' WOOD STOVE � <br /> DRINKINO FOUNTAIN i METAL FlREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNINO) ' <br /> BACKFLOW PREVENTERS ; OAS FIREPLACE � <br /> � SINK(SERVICE—BAR,ETC.) � aAS RANOE ; <br /> � OAS PIPING � <br /> ; EXHAUSTFAN � <br /> — , ' <br /> i i <br /> � T <br /> 1 <br /> � SUB TOTAL S ' <br /> SUB TOTAL S i <br /> PERMIT S � PERMIT S � <br /> TOTAI FEE S ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB�CK PEAqSEiB�CK SIDESETBACK PUNCHECK�B�R FEE RECEIPTNO. <br /> Lf <br /> USEZONE LOi�RE� ��C�NTSITE FEES VALUATION FEE <br /> i <br /> ❑YES ❑ NO OUILOMG i <br /> MEIOHT LIMITATION NO OF�Y/El UNG SIZE OF BLDG�TI. i <br /> UNITS p�UMBING � <br /> OCCUPANCY NO OiSTOPoES OCCUPANTIO�D B�SEMENT MECIIANICAL I <br /> ORWP — <br /> ❑YE$ fl NO � <br /> �DDITIONAL PUN CNECN � <br /> FlREALARMREOD REASON <br /> � <br /> OTHER i <br /> RRE$PRINKIERREOU RE�SON i <br /> STRTE BWLUING SIIRCHARGE � <br /> TYPEOFCONST PUNSRPPROVEDBY CITYOFEVERETT P�BLICWORKS i <br /> LOCAL SALES � <br /> DATE TAX CODE IS 3105 TOTAL <br />