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APPLICATIVN FOR CONSTRUC110N PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> f-1 nEMOUTION COMBINATION I-I BUILDING f-1 MECHANICAL f l PLUMBING f l SIGN <br /> PROJECT DDRE S <br /> - 10 E - A 2a 1 <br /> OWNER MnILR00RES5 CIiY ZIP PNON[ <br /> �.{�'Kl�girf ' `1 al)lo- �3`I�rlt �J S �SrIU ►iom��1} �l8'2�tn 3In0 �5ing-�'13q <br /> TF.NA� � ^ MMLADDRF.55 f.ITY zIP PHONE <br /> F" <br /> ARCHRCCT OR IJESIGN[R MAII.AOORESS CITv 71P PNONF � <br /> GENG(1PLCONTR�CIOR MAIIPODRESS CIiV 71P PIION[ Sin7LlICGNSE• <br /> MECNANICALCONTRACTOfi MPIL�OORESS (;ITV ZI{' PIIONE Si�Tf:110EN5E• <br /> PLVMB GCONiRACTOR MAILADDRE55 Cltt IIP PHONE $TATELIGENSE� <br /> �r� Gao � <br /> CONTRACT PRICE OF WOI1N <br /> HEATING SYSTEM: 1 1 GAS 6Q ELECTRIC f 1 <br /> OESCPIBE WORK�ND SOU�RE FOOTAGE INVOLVED CO TACT PFRSON�Np IIONE NO. <br /> � ! .7 � <br /> ` <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSE�USE OF BUILOING APPLICATION AND KNOW THE SAME TO BE TRUE ANU CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALOESCBIPTIONOFPqOPENTV�S WNBEIOWOR�ifAc�Twocories�� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> lOi___�_�_BLOCK�pF ���/k �� �'�i J AUTHORITY TO VIOLATE OR CANCEL THE PFOVISION OF ANY <br /> 1'' /7 / OTHEF STATE OR LOCAL LAW REGULATING CCNSTFUCTION OR THE <br /> Lv fLe�L"� � LGSS GJ�i F�' {w/' v!I t+ PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERPORM THE IVORK FOR WHICH <br /> SI� a G � (, o APPLICAT�ON IS MADE AND I COMPLV WITH THE STATE <br /> PARCEL TA%I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRVCTION LOPN LENOER,AODRESS.TELEPHONE NUMOER x���_„� l� `/��p� <br /> SIGNRTUPE � DFiE <br /> CITY BUSINE55 LIC[NSC NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—NHNDLGUNITS—H.P. � <br /> I BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> � LAVATORY(WASH BASIN) HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS � <br /> DISHWASHER � �-z VENTILATION FAN � <br /> LAUNDRY TRAY ; qANGE HOOD ; <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE <br /> DRINKING FOUNTAIN � METAL FIREPLACE(OVOOD BURNING) ; <br /> FLOOR DRAIN � FIREPLACE INSERT(WO00 BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE <br /> ' GAS PIPING <br /> � E%HAUSTFAN � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL S ; <br /> PERMIT 5 i PERMIT 5 � <br /> TOTAL FEE S � TOTAL FEE S � <br /> FOR OFFICE USE ONLY: <br /> fRONTSF.TPACK PEARSF.T9ACK S�DESETB�CN Pl�NC11ECNNl1MOGft fEF �ECEIPiNO. <br /> � <br /> usezor+e iornnen VACANi511F FEES VALUATION FEE <br /> f1YE5 I1 NO T— <br /> ouuoiNc p GOO <br /> HEIGIITUMIU110N NOOfUWFLLING SIZLOFBLDG4� � � <br /> UNI15 � � J PWMOING L..� <br /> "�� LLl_ <br /> OGCUPRNCV NO 0�S�ONiES OCCUPANL LOAD 045EMF.NT MECNnMCnI /� <br /> cnour <br /> u �„ES V'Fi� — — -- <br /> FIRE�URMRE00 RFASON ADpIIlONr1LP1ANC11F.CK <br /> _�__ <br /> on�¢n ; <br /> FinesrniNHtFnaFon nencoN — <br /> stme ounowc sunr.��nnce �� <br /> — �— <br /> rmeorr,orust rtnNsarvnovEnnv CITYOPEVERETT rnmicwo�Hs ' <br /> �t- � LOCAL SALES -'— <br /> _]L:� „�,E { ZS Q�O TAX CODE IS 3105 Toin� 7 I [) <br />