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APPLICATIC�1 FOR GONSTRUC'�:ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEUAR STREET• EVEFlETT,WA 98201 •259•8810 <br /> C7 DEMOLITION Cl COMBINATION fl BUILDING C7 MECHANICAL t� pLUM81NG fl SIGN <br /> PROJECT ADDRESS ♦ <br /> »fi i U <br /> ONTiER M�ILADDRE55 ' Gtt Zi� PHONE <br /> 7e,.�ti•;s C'...1 t,w 7�,� �i 't � S_C� '�S{e✓�,�� Y�-zs�- 33 y'-3�77 <br /> I�EN��NT /� M�IL/�pDRE55 �ITY IIP i+MONE � <br /> ?�t'n.�iS ( �i r�SJw.� <br /> MCHITECTORDESIGNER � M�IL�DDRESJ Cltt ZIP PHONE <br /> �.�nmrnts�D,� /�trlG,i.� .zyrd�G'�1ti1. (;»-,�— fhai .�-1-91-P�o <br /> GENER CONT{IRCTOR M �DDR 5 T—�� �IfV )IP PIIpNE $IATEUCENSE� <br /> ��--'.�,�is �'or�DN 7/� //S�' a ,r �f•,C S'-bu�- q��.kf" 33Y 3677 �En�,v/cC /SY}�� <br /> MECHANICRLCONTRACTOR MAILADDRE55 CI7V ZIP PIIONE STATELILENSE� <br /> PLUMBING CONTRACTIXi M�q 11DDRE55 LITY ZIP PHONE STATE 4^ENSE� <br /> � w �� -T�' � � 0 9 Za �S.S'G/7 <br /> CONTRApT PqiCE OF YIpiK <br /> •X � p HEATING SYSTEM: GAS fl ELECTRIC fl <br /> DESCR�BE WQRK AN $pUARE FOOTAGE INV VEO . �pNTACT PEPSON D PNpNE NO. <br /> �a�u t--� '-� r a • < _ <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> P SEO USE OF BUILOING , � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � a �'��--� WO KISWINI BE C MPLIED WITFiNW ETHER SPEC F EOHHEREIN OR <br /> L AL�OES�CR�I,P/TIONOFP P�`TY/f��SN,OW^N,�B,�EI.CWO�RATUCHTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> wt-y�%e�ocK_LC�Xl1oF L [.r� � AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> �� _ OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> �U PERFORMANCE OF CONSTRUCiION.THAT I AM AUTHORIZED BV THE <br /> PMCEL�TA%ID.�BER � �r R�i�� �'� CONTRACOTORSLAW A.D27 CWAND2s6.2ppLWA�WI HRKT ER ST TE <br /> 5!�'7l — � � — v C <br /> �CO TRUC-p(�ON IOAN/��jy O_ER�.I`�pp'RE55.TELEP110NE NVMBER .Q� • / a Y <br /> I�-�ZMLYi M. (JQ+� �. .S .I/�. U 5 GNATURF O�i <br /> - CITY BUSINESS UCENSE N0. <br /> PLUMBIN6 MECNANICAL <br /> ' NO. TYPE OP FlIfTURE Oq ITEM NO. TYPE OF EOUIPMENT FEE <br /> � � WATERCLOSET(TOILE� � A/C—qIHNDLOUNRS—H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. A7 E.A. ' <br /> � � <br /> IAVAT�RV(WASH BASIN) � HEAT PUMP � <br /> HOWER � UNITHEATERS—B.T.U. M � <br /> K HEN SINK 6 DISP ; CLOTHES DRVERS ; <br /> DIS ASNER � NTILATION FAN � <br /> LAUND TRAY ; RA E HOOD ' <br /> � <br /> ClOT}iES SHER � WATE HEATER � <br /> URINAL ' WOOD S VE � <br /> DRINKINCa FOU � METAL FIH ACE(WOOD BURNING) � <br /> �— <br /> FLOOR DRA � FIREPL I RT(WOOD BURNING) � <br /> BACKFL PREVENiER � � GAS EPLACE ' <br /> � <br /> SINK ERVICE—BAR,ETC. RANGE � <br /> ' GAS PIPING <br /> i EXHAUSTFAN i <br /> � i <br /> i � <br /> � <br /> T <br /> SUB TOTAL E � SUB T TAL S � <br /> PERMIT E i PERMIT S � <br /> TOTAL FEE S � u„� TOTAI FEE � <br /> FOR OFFICE USE ONLY: Cj�/(n,73 t-/c/ (oU ' �p ,�,�� <br /> FRONT SETP�CN PEAR SETBACN SIDE SETB�LN / i��1N C11ECK iUM9ER FE[i2 �.� REf.EIPT N0. <br /> S <br /> useiorue ' wrnnen vncnNtsrte FEES VALUATION FEE <br /> ��� f1YE5 IiNO Bl1ll0itl(p i <br /> IIEIGIIT L / NOI OF UWELIING SIIE OF BlIX:rtl -- � � ������ <br /> � / O� P�UMOING � <br /> le J � <br /> OCCUP�NCY NO 0�SIOaiES OCCUP�NI LORO B�SEMENT � <br /> f. UP 3 �,A MECII�NiCAL — -'_'--_ i <br /> fIYES f NO � <br /> FIRE AURM REO'C 11fI.50N �DDIIIONM PL4N CHf:CN � O <br /> �(o� �— <br /> � <br /> �5 �n p o���en � <br /> FIRF.S. 1'POMIERnE00 �FASON • � — <br /> ��! (f�� C (��� STNE OIIIIDMG SUf1C11AROE — /O �� <br /> J 7 <br /> trrEorr,or+sT rinHsnn oveoAr CITYOFEVERETT ruour.wonKs ' <br /> V.. � y2 � LOCAL SALES - -- � 'r=� <br /> ___ onre s— �— TAX CODE IS 3105 TOTAL ,j� �/ �7 <br />