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APPLICATIOrI FOR CONSTRUCTION PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> �l DEMOLITION �l COMBINATION f� BUILDING f�MECHANICAL �LUMBING f 1 SIGN <br /> PROJECT ADDRESS <br /> 1 � „✓ � !IC � �� <br /> �O EA MAILADDRESS CTV 21P p110NE <br /> � N��nl<� .� o Ic 17�i��'�l,i ��1����p �J-9R�o� 3y z-� �- . <br /> IEN�NT � M411.ApDRCS� CITY <br /> ziv ri�or�E <br /> PRCMITf.GTOR OESIGtI[R �MIII qDURE55 Cltt ]iP PIIOk <br /> Ql�(� (] � <br /> NEt1A�CONiR LLOR MAllA0pRE55 CI1V iP PII N[--���� 9�qiFll ENS <br /> t�1 l„ �T�_��F �-r��2 'r�l��;�r,� ��I���� z`X�- �/ �n�� <br /> AECNANICAlLON7RAC70(i MAILAD PE55 IiV��_"—r ji�p p�l UE STAtFII�.-115E� <br /> �� '� <br /> PLUMBINCaCONiRnCTOR MAIL�DL� S CIi� ZIP ppONE STATELICENSE• <br /> � <br /> GONTRACT POICE OF WOfiN " � <br /> - � HEATING SYSTEM: yi c�AS �l ELECTRIC f 1 <br /> DESCRIpE WOPK ANO SOUARE FOOTAGE INVOLVEO CONTACT P[RSON�ND PIIONf:NO <br /> � Eo� <br /> (l�. I , „n — <br /> � � Q � I HEREBY CERTIFY THAT I HAVE READ AND ExAMINED THIS <br /> Pnoroseo use oF eui o APPLICATION AND KNOW THE SAME TO BE TRUE AN�CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNI�G THIS TYPE OF � <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEi7EIN OR <br /> LEGALDESGRIPTIONOFPROPERTV�SMOWNBELOWORqTTA�I{TWOCOPIE51 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PRO TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS ADQ AND I COMPLY WITH THE STATE <br /> PARCEITA%I.D.NUNBER CONTRACTOP AW 1827 RCW A 96.200 WAC. <br /> � ��� <br /> CONSiRUCPONLOANLENOER.RDDBES ,TEtEPNONENOMBER X <br /> SIGNALURE OaTE <br /> CITY BUSINE55 LICENSL NO <br /> . PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OP EOU�PMENT FEE <br /> . WATERCLOSET(TOILET) � A/C—A/HN�LGUNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.� M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCIiEN SINK&DISP i CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAV ' RANGE HOUD <br /> � <br /> CLOTHES WASHER � WATER HEATER , <br /> URINAL WOOD STOVE � <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) ; <br /> FLOOR ORAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) GAS fiANGE , <br /> GAS PIPING <br /> � EXHAUST FAN ' <br /> i � <br /> � � <br /> SUB TOTAL 3 ; SUB TOTAL S � <br /> PEFMIT 5 i PERMIT $ �— <br /> TOTALFEE S ' TOTALFEE 5 � <br /> FOR OFFICE USE ONLY: <br /> IRONTSFTPACK RE�fiSFTBACN SIDESETBRCN PIANCnECNNUM0E11 PEF RECFlPiNO <br /> ���7� <br /> usezoNe ioinnen WCANISIIE pEES VALUATION FEE <br /> _ i�ves i; no ouunir+c � <br /> IIEIGIITLIMIfATION NOOGOWELLING SIZEOFBLDGRI <br /> ��N��G PLUMOING <br /> OCCOPRNCY NO Of$fORif$ OCCUPANT LORD OASE0.1EN7 —�— <br /> GROUP MEC114MC�L <br /> I IYES I I NO � _ <br /> FIREAL411MREOD RFASON /�DIIIONAIPLANCNECK <br /> �+-- <br /> OIIIER <br /> fIRFSPRINNIERPF.O�� RFARON � <br /> STFiC Ol11lDl`!G SURLIIAtlGE <br /> i <br /> ivrEorr,ousr r�nrvsnrrnoveoov CITYOFEVERETT runnr,wo�Ks <br /> LOCALSALES — — _ _-______ I____ <br /> uart TAX CODE IS 3105 TOTAL <br />