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APPLICATI�.A FOR CONSTRUC't �ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOLITION f 1 COMBINATION j� BUILDING fl MECHANICAL �1 PLUMBING fl SIGN <br /> PROJECT ADDRESS „ i � Z /��� �`� <br /> � 0� <br /> OWNERr � MAILA00 5���� �G��/� 21P �� � PHapG ����^J��y <br /> � � <br /> . 9�� <br /> T NANT MRIL DORE55 CITY IIP p1/0NE <br /> ARCHRFCTOROESIGNEii MAl1.A0�RE55 Gltt 71P PHONC- <br /> GENER�LCONTf1PCTOp MAILADDRESS CIIY ZiP PHONE STATEUCENSE� <br /> DuhtG�J <br /> MECH�NICRICONTRRCTOR MAILAOOPE55 CITV ZIP PIIONE STATELICENSE� <br /> PLUMBINGCONTR�CTOP MAILADDRE55 CIIY ZIP PHONE STATELICENSE� <br /> CONTR�CT PRICE OF WOf1K <br /> HEATING SYSTEM: IIGAS fIELECTRIC fl <br /> OESCRIBE WqiK AND SOU�RE FOOTAGE INVOWED 1 CONTACT PF.RSON�N�PIIONE NO. <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPoSF.D USE OF BUIlDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> Y'I U4,'PF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN O!i <br /> �e �LOESCRIPTIONOFPROPERTV�SN WNBELOWORATiACHTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> wr eiocK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATtON IS MADE AND I COMPLY WITH THE STATE <br /> PMCELTA%I.D.NIIMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTIONLOANIENDER.�DDiiESS,TELEP110NENIIMBER x��[G{/l.c� [.����^,'-f:Gf�'LY (1 � (�� �/� <br /> SIf.NRTURF. Ur1TE <br /> CITY BUSME55 LICENSG NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TVPE OF fl7RURE OR ITEM FEE NO. TYPE OF EGUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLO UNITS—H.P. ' <br /> BATHTUB ; FORCEDAIRSVSTEMS—B.T.U. M E.A. ; , <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK h DISP � CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> UUNDRY TRAY � RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIAEPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR, ETC.) GAS RANGE ' <br /> GAS PIPING <br /> � EXHAUSTFAN � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL $ ; <br /> PERMIT $ � PERMIT $ � <br /> TOTALFEE $ � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> lRONTSETPACK PEARSF.TB�CN SIDES[TBACN �l�NQ1ECKktIMFlC:R f[f RECEIPTNO <br /> USE20NE �or�nen V�CANf511F FEES VALUATION FEE <br /> f IYES !i NO p10101NG �/ I i /J <br /> HEIGHTLIMITATION NOOFDWELLING SI2EOPBLD(iRl � <br /> IINIiS PIUMIIIN. � <br /> � <br /> pCCUPANCV ND Ot SIOPIES OCGUPANT LOAD B�SEMENT MFf,114NIC4l � <br /> GRW�' _ <br /> I IYES Il NO � <br /> FNE�URM REOD �EAS(NJ ADOIIION�L PI.AN CIIf.CK - <br /> i <br /> O1flGR i <br /> FlRESPRINKLE��[00 �F.A$ON � <br /> sTnienmioinrsunu�nnec / ;J�) <br /> +— <br /> ivre or r.oNsr rtnNs nrrnov¢n or CITY OF EVERETT rum ic wonKs ; <br /> LOCAL SALES �— � ,-,—� <br /> ��q�� TAX CODE IS 3105 70TAL <br />