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APPLICATI�.N FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, 1VA 98201 •259-8810 <br /> ❑ DEMOUTION f� COMBINATION jN BUILDING �l MECHANICAL fl PLUMBING fl SIGN <br /> PROJECT ADDRESS <br /> OWNER MNLRODBE55 Gltt 21P PHONE <br /> �tR [�� 2AfEL t �os Pir{z �c����r�i� �vv� ��z¢� Z���� '-`I°3 <br /> TENANT MAILA�OP[SS CI1Y ZIP PHONE <br /> ARCHITECTOHUESIGNER MAILADDRE55 CITY 21P PIIONE <br /> GENERAICONTRACTOR MnILRDDRE55 GI7Y 7.IP PIIONL STATELICENSE� <br /> a Prmi�Rst� '� cs�o �,.razc�r �va� q�� Zs�-7�sa l� ►'�+vr+�'�c�G=�5 <br /> MECHANICALCONTRACiOR MAILAUORESS CIN 21P P110NE STATEUCENSE� <br /> PIUMBINGCONTRACTOR MAILAUORE55 CITV 21P PHONE STATELICENSE� <br /> CONTRACT PRICE OF WORN <br /> �q �^'�� ���� HEATING SYSTEM: ❑GAS ❑ ELECTRIC fl <br /> DESCR10E WORN AND SOUARE FOOTPGE INVOLVED CONi�CT PGRSON ANO PHONF NO. <br /> � 'Y�+tG ' cd�i�.� �'-`t—7 Z�so <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSEDUSE OF BUIoLDING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> I7N"r�- �R� WORK WILL BE COMPLIED �NITH WHETHER SPECIFIED HEREIN OR <br /> LEGAlDESCRIPTIONOFPROPERTY(SHOWNBELOWOHRTTRCHTWOGOPICSI NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ors 3�y BLOGK 2�� or r V AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> . T � O S1�Wl � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> ,.'�L/J� � q�/dJ _ �J� _,_ti.�n? APPUCATION IS MADE ANO I COMPLY WITH THE STATE <br /> �' - CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> PARCEL T!1%I.O.NUMBER <br /> � ���� 3��tl/Q� <br /> CONSTRUGTION IOAN LENOER,�DDRE55.TELEPMONE NUMBER x <br /> SIG PTURE O�TE <br /> CITY BUSINESS UCENSE ND. <br /> PLUMBINO MECMANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF F�%TURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—A�HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) i HEAT PUMP ' <br /> SHOWER ' UNITHEATERS—B.T.U. M ' <br /> CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � ' <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRYTRAY ; RANGE HOOD i <br /> CLOTHES WASHER � WATER HEATER y _ <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) <br /> FLOOR DPAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE ' <br /> � GAS PIPING � <br /> � EXHAUSTFAN ' <br /> � <br /> � <br /> i � <br /> SUBTOTAL 5 ; SUBTOTAL $ ; <br /> PERMIT S � PC-HMIT 5 � <br /> TOTALFEE S ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SEiP�CK/ REAR SETBACK 90E SET9PLN PIAN CNECN NU�19ER FEE � RECEIPT NO. <br /> � s r X �7 7� �s 39<<S <br /> use cr+� � LOTAREA VACRNTSITE FEES VALUATION FEE <br /> � <br /> flVES f1 NO OUILDING 965 � <br /> MEIGNTLIMIT110 NO.OFOWEWNG SIZEOFBIDGRI. /� � <br /> Z 1 UNIT$ 5�� S,L {��A�+E PLUM�ING � <br /> OCCUPRNC/ NO O�Si0P;E5 OCCUPANT LORD BASEMENi MECHANICAL I <br /> GROUP � <br /> �' ❑YES l 0 � <br /> FIREAUPMRE00 �EASON AODIiIONRLPUNCHECK � <br /> T <br /> �� O711ER � <br /> FIRE SPRINKLER FEO'D RE�SON ��� <br /> ^�O STR7E�UILDING SURCIIARGE �� <br /> T'PEOFCONSi. PIANSAPPROVEDOY qTYOFEVERETT runucwon�s � <br /> LOCAL SALES �7n ' <br /> �"h.� OAIE TAX CODE IS 3105 TO7AL G d � �J <br />