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APPLICATION FOR CONSTRUCTIVN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOLITION fl COMBINATION fl BUILDING fl MECHANICAL f� pLUMBING fl SIGN <br /> PRQJECTADDRESS •�' _3� / <br /> d �ir�Ci(,l���ev � _�l✓ .��_ <br /> O ER MI1IL�OURE55 CITY ZIP pNON[ <br /> e24�t1J��4c� 'Z� 3/ G'-G,.d�c�rr4, � I/l� �dr 98�03 J/J ��25 <br /> TEN�NT I.IqII�D�RESS CITY ZIP PHONE <br /> �RGNRF.CTOROESIGNER MRIL�DORE55 �Itt 71P PMONE <br /> GENEfiALCONi(IAC70R MAIL�OORESS CI1Y )IP p110NE SiATEUC[NSE� <br /> MECHIINICAL C�yNTRAC7.�0 MML ADDRESS CITV ZIP PIIONE STAiE LICENSE� <br /> �i�7`7�'e i-�,�/act s�/Z £�tZbn�.,, 4�y �/r�c �8�3 3�3�372Z �� <br /> PLUMBINGCONiR�CTOR MAILADDRE55 Cltt ZIP PHONE SiRELICENSE� <br /> CONTMCT PRICE Of <br /> (/�? HEATING SYSTEM: �,,YGAS �l ELECTRIC �"1 <br /> OESCRIBE WORK ANU SOUr1RE FOOTAGE INVOyLV�ED � CONTACT PERSONAND PMONE NO. <br /> iV ' l /.ifC�/ Cl/"i� / l� <br /> I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> VROPOSEDUSEOFBUIIDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.qLL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALOESCRIPTIONOFPROPERTY�SHOYMBELOWOR�TTACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL T/Of 1 D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUCIIONLOANLENOER,�DOHESS.TELEPHONENlIMBEP x�� �C�'`�� � ( �fc+ �5 � <br /> SIG�URE OATE <br /> CITV BUSINESS LICENS[NO. <br /> PLUMBINO MECXANICAL <br /> NO. TYPE OF fll(TURE OR ITEM FEE NO. TYPE OF EOUIpMENT FEE <br /> WATER CLOSET(TOILET) � A/C—AhiNDLG UNfTS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> IAVATORY(WASH BASIN) � HEAT PUMP T <br /> SHOWEfl � UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 6 DISP ; CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRYTRAY ; RANGE HOOD ; <br /> CLOTHES WASHER � WATER HEATER � � <br /> URINAL � WOOD STOVE ' <br /> DRINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GASFIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE <br /> ' GAS PIPING <br /> i EXHAUSTFAN � <br /> � � <br /> i � <br /> SUB TOTAL S ; SUB TOTAL $ ; <br /> PERMIT $ i PERMIT $ � <br /> TOTAL FEE S � TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETPACN RERR SF.TBACN SI�E$ETPACN PI AN CIIECN N ��ER /J PEE �ECFIPT NO <br /> 7_.���' <br /> USE20NE ior�nen l'RCANISIIE FEES VALUATION FEE <br /> f 1 YE$ (1 NO OUILDING ' <br /> � <br /> HEIGMT LIMITATION NO OF DWEILING 512E OF 9LDGT i <br /> IINIiG �111NAING i <br /> OCCUP�NCY NO 0�StOmES OCCUPANT L04D BASEMENi i <br /> OROUP MECM�NIC/.L � <br /> IlYES II NO ~— <br /> FIREQARMREO-� RFr150Y A�OIIIONAIPIANC11f.CN <br /> � <br /> 0711ER � <br /> � <br /> FlRF.SPRINNLERRf:O'D RF�SON � <br /> STAI[OUIIDING SUfiC1lABfiE i <br /> rvrForr,or+si rinvsnrrnovFonr CITYOFEVERETT PUFlIICWORNS , <br /> LOCAL SALES - —�'— <br /> ��A�E TAX CODE IS 3105 TOTAL <br />