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APPLICATI�1 FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT.WA 98201 •259-8810 <br /> ❑ DEMOLITION fl COMBINATION fl BUILDING f�l MECHANICAL �1 PLUMBING f l SIGN <br /> PROJECTADDRESS I��� �/�nti� �UC <br /> /�H <br /> {'110NE <br /> M�LAODRE55 � ZIP �`, `� <br /> �j�"Ati�N .��'C?�� � _C " - <br /> ���, Z�p PNONE <br /> IEN�NT MAIL�ODRESS <br /> ��ry 71P PNONE <br /> �RCNITEGT OR�ES�GNER MPII ADDRESS <br /> ��t� Z�p PHONG SIAT[UCENSE� <br /> GEN � �ONt����` MRRAODRE55 �n�� ���—��Z� <br /> /� �fj / /,�� <br /> C"�%� IN �U. rJ"�� J`��1� C U�� n � STA7EUCENSE� <br /> MECH�NICAICONTRACTOR MMLADDRE55 <br /> GTV Di PRONE <br /> � ��P, Z�p PNONE $TAiE LILENSE• <br /> PWMBINGCONiRACtOR MA�LADDRESS <br /> �CO TR�C�J7 PRICEOF� HEATING SYSTEM: I,�GAS fl ELECTRIC f� <br /> I `��� GONi�GT PERSON RNO P/IONE NO �n� �S � _�//�/ <br /> DESCRIB VIO%IK�NO SOU�RE FOOUGE INVOLVED r� t" <br /> �,��.�c� 3 So�o�o GT�.� �/�`r. rAs <br /> Fd,�NfrCe'S %yw r. Z -�.� CP,C' s <br /> � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> , �j) A ��-7Al2�`E X<�A�T �N APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT ALL <br /> pppf+O5E0U5EOFBUIL01N6 � �n PROVISIONS OF lAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> iEc�oEscnirn�AorEarv!sNowr�ElOW OR�7 PL TN��COP�ES� NOT. T EILGRANTINGPOF A PERMIT DOES NOTEPRESUME TO GIOVE <br /> r <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF A <br /> _aT BLOCN oF OTHER STATE OR LOCAL L:\W REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 7827 RCW AND 296.200 WAC. <br /> pMCEI TN(1 D.NUMBER ^ � /����/�� <br /> ,����' /�'�;._ <br /> CONSTRUCTIOPo IOAN LENDER.ADDRESS.TELEPHONE NUMBER SIG1 R UHE DAIC <br /> CITY BVSINESS IICENSE NO <br /> PLUMBIN6 MECHANICAL <br /> FEE NO. TVPE OF EOUIPMENT FEE <br /> NO. TYPE OF FlXTURE OR tTEM - , <br /> WATER CLOSET(TOILE� � A/C-�NDLG UNITS-H.P. <br /> � 3 FORCED AIR SYSTEMS-B.T.U. M E.A. � <br /> BATHTU6 - ' <br /> HEAT PUMP � <br /> LAVATARY(WASH BASIN) � UNIT HEAtERS-B.T.U. M <br /> SHOWER , � <br /> KITCHEN SINK 8 DISP � CLOTHES DRVERS <br /> DISHWASHER � VENTIIATION FAN � <br /> LAUNDRV TRAY ; fiANGE HOOD _ ' <br /> CLOTHES WASHER � WATER HEATER � <br /> � WOOD STOVE � <br /> URINAL � METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN , FIREPLACE INSERT(WOOD BURNING) ' <br /> FLOOR DRAIN Z ; <br /> BACKFLOW PREVENTERS ; GASFIREPLACE <br /> SINK(SERVICE-BAR,ETC.) � GAS RANGE � <br /> � �n GAS PIPING <br /> ' EXHAUSTFAN � <br /> � , <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S �� <br /> PERMIT R �' <br /> PERMIT S ' TOTAL FEE S <br /> TOTAIFEE 5 ' <br /> FOR OFFICE USE ONLY: �E� nEcemrr+o <br /> fRONTSFiPACK REA�SETB�CN SIDE SETBALK <br /> PL�N CIIECK NUMOf:II <br /> FEES VALUATION FEE <br /> �SE20NE LOT�REA V�CANiSRE i <br /> fIYES IiNO pUIlO�NC �-- <br /> HEIGIITIIMITA�ION NO.OFUWEILING SIZEOPALUG/T� i <br /> UNIf$ plpM(9NG ---�— <br /> i <br /> � <br /> OCCVPANCY NO OiS�M�IES OCCUP�NTIO�D B�SEMENT MEGIANICM <br /> f.ROUP f 1 YE5 Il NO i <br /> ADDIIIONAL t"AN G�F.CN <br /> �— <br /> FIFEAIARMREOD RFA504 � <br /> OTMER � — <br /> i <br /> FIRESPRINRIERRFOD AEASOn1 � <br /> STP1E BU4�MG SIIRC114t1GE � <br /> �"� <br /> TYPEOFCONSi PLANSAP{`POVEDBV CITYOFEVERETT �UPIICWOPN$ _ _ <br /> LOCAL SALES ; <br /> u�TE TAX CODE IS 3105 TOTAL <br />