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� <br /> APPLICATI.�'N FOR GONSTRUC'. .ON PEiRMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> DEMOLITION Cl COMBINATION f� BUILDING ❑ MECHANICAL �� PLUMBING fl SIGN <br /> PROJECT ADDRESS � <br /> u <br /> OWNER MAI�ApppiGS CITY 21P PMONE <br /> 1�eNn.iS_�',.Lt�w 7/.� ��s�a.,� S E �/�S�rii.�1 9d-zsd— 3TY-.?677 <br /> TENANT /� MAI�ADDRESS CITY ilP PHONE � <br /> �nr�.fS ( n r�SJn� <br /> ARCMITECTORDESIGNER MAILADORE55 CITY IIP PMONE <br /> �5,�� �l.>rrc,.tJ ..ZS'��- 4'��-rH-' yhe� �?S'1-91-l�0 <br /> GENERK CONTpA�iqi M AOOR 5 � C11Y ZIP r110NE SiATE LICENSE� <br /> ��.�%S Cor�D..� 7/� //S� a��a SF•�� S-�bc�' q�-1.�" �3Y-367T ('�E�,vICCISYt�� <br /> MECHIWICALCONiR�CTOR MAIL�DORE55 CITY ZIP PIIONE S7ATELICENSE� <br /> %UMBINC CONTRACTOi1 MAI�GppRE55 CITY IIP PHONE ST�TE U^.ENSE� <br /> �� .sf• � � 0 9 za SS=G/7 <br /> CONTR�CT iRICE OF WORK — <br /> � HEATING SYSTEM: • . GAS f-1 EI.ECTRIC fl <br /> DESCRIBE RK AN SOUARE FOOTAGE INVO�ED CONTACT PERSON D PHONE N0. <br /> r �7 � - <br /> �', f= I� <br /> � 1 HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PIIOPOSED VSE OF BUILpN6 APPLICATION AND KNOW THE SAME?'O BE TRUE AND CORRECT.ALl <br /> - , PROVISIONS OF LAWS AND ORDIIIANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITF 'NNETHER SPECIFIED HEREIN OR <br /> �c��yoes�ca,rm,/narrocc PE`tt/t(�S,NOW�,NMBELOwOR�TfACNTWOLOPIES��/ NOT. 7HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �Or'.�_BLOCK�1�XJ1oF (X�r �I IAT AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> ��/�y�a �—/> — OGHEORMANCE OF CONSTRUCTION.�THAT I AM AU HOR12E�BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> r APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> . PMCEL TA%I.D.MIMBER CONTRACTORS LAW i827 RCW AND 296200 WAC. <br /> Y3`'1l -y�z - vo - . <br /> �TRUC�ON LOAN�I OER.�RESS.TEtEPHONE NUMBEH p� � <br /> 4f�i.�QM2- .g.3.? S•GJ. t�.nr U SIGNATURE o�T <br /> CITY BUSINESS LICENSE N0. <br /> PLUM81� MECHANICAL <br /> TYPE OF FlXTURE OR ITEM FEE NO. 7YPE OF EGUIPMENT FEE <br /> WATERCLOSET(TOILET) � PJG—AMNDLOUNITS—H.P. � <br /> BATHTUB ; FORCcO AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) i HEAT PUMP i <br /> SHOWER � UNIT H':ATERS—B.T.U. M � <br /> KlTCHEN SINK 8 DISP ; CLOTHES DRVERS i <br /> DISHWASHER � VENTILATION FAN �— <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CIOTHES WASHER � WATER HEATEF � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURN�NG) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; y/ AS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � S RAN6E � � <br /> ' AS PIPINO <br /> � EXHAUSTFAN <br /> —�— <br /> � � <br /> � � <br /> _ ' <br /> � � <br /> SUB TOTAL S ; SUB TOTAL E ; <br /> PEFiMIT S � PERMIT S � <br /> TOTALFEE S ' TOTALFEE 3 � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIOE SETBACN PUN CIIECK NUMOER FEE RECEIPT N0. <br /> 51��3 <br /> USEIONE IOTAREA V�C�NTSITE FEES VALUATION FEE <br /> � f1YE5 fiNO BIIIIDINC i <br /> IIEIGIR(�MIT�TION NO.OF�WELLING $IZEOFBlIX3RA. � <br /> UNIfS � <br /> P111M01NG i <br /> ��� <br /> OCCVPANCY NOOtSIpHiES OCGUPANTLOAP B�SEMENT MECN�rII�AL � <br /> G�WP <br /> f1YE5 I7 NO ' <br /> FIRE AURM REOD qF.A50N aDDITIONA�fLGN CMF.CK � <br /> _ � <br /> OtNER � <br /> i <br /> FlPESPRINKIERNEOD PE�SON -- � <br /> STNE OUILDMf.5Uf1CHARGE <br /> TYPEOFf,ONST PUNSnPPROVEOBY CITYOFEVERETT �UBIICWOtiNS � <br /> i <br /> LOCAL SALES -- — <br /> DnTE TAX CODE IS 9105 TOTAL I <br />