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�r� <br /> APPLICATION FOR CONSTRUCTI�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> • 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> f� DEMOLITION fl COMBINATION (-1 BUILDING MECHANICAL rl PLUMBING fl SIGN <br /> PROJECT 4DDRESS ��3 oAKES �VE• �✓E� I ( �(/i�. / �C! <br /> ONTlER MAILADDRE 5 CITY 21P PNONE <br /> J�A��/IEL LD uJ�✓/R� �303 OA�S A�: E✓���, �✓A-. 9820/ ?s9-S�TjX - <br /> TEN�NT MNLADORf.55 CITY ZIP PHONE <br /> �RCHITECTOR�ESIGNER MRII.A�ORE55 GITV 21P PNONE <br /> D G�/,�1B�L <br /> GENEP�ICONTp�CTOR MAILA��RE55 Cltt LP PIION[ SiAiGIICENSE� <br /> O w�uE� <br /> MECHRNICALCONiRACiOR MRILRDDRE55 CIN 2IP PIIONE STA7ELICFN$E� <br /> Noer�c�Esr 1�ryr�r�� . I'�✓c • ,od•�X �77 . Cu�lTo�1 . ��: 9 8�3��� <br /> PLUMBINGCONTRRCTOR MAILPDDRESS Cltt ZIP PHON STATEUCENSE• <br /> o/LT�fTl S� L <br /> CONTP�CT PRICE OF WORK <br /> HeATING SYSTEM: 1�GAS (-I ELECTRIC (l <br /> OESCRIBEWORK�NUSOURREFOOTAGEINVOLVED CO TACTPERSONAN�PHONJwO. I �� _36/S �ELL.T' <br /> /��TN <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEU THIS <br /> Pi10POSEU USE OF BUILDING APPLICATION AND KNOW THE SAME 70 BE TFUE AND CORREC7 ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF � <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGIILDESCRIPTIONOFPROPERTY�SHOWNBELOWOq�TTACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVF <br /> ior_ _e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCEL TNc I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTON IOAN LENOER,AUDRE55.iELEPNONE NUMBER X U �(//���' I � � <br /> SIGN�T RE OATG <br /> CITV BUSWE55 UCENSG NO <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> ' WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. ' <br /> BATHTUB ; FORCEDAIRSVSTEMS—B.T.U. M E.A. ; <br /> LAVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 6 DISP i CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD ; <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL � �YB9DSTOVE /fT• �j/f5 ' <br /> DRINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOQ BURNING) � <br /> BACKFLOW PREVENTERS ; GAS F�REPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> � GAS PIPING <br /> ; EXHAUST FAN � <br /> � � <br /> SUB TOTAL 3 ; SUB TOTAL S ; <br /> PERMIT 5 � PERMIT S � <br /> TOTAL FEE S ' TOTAL FEE S :� ' <br /> FOR OFFICE USE ONLY: <br /> fRONT SETpqLN REAR SFTBACN SIDE SETBRLN �'LAN CHECK NUM9ER FEF REf.F.IPT NO <br /> / � _ <br /> usezoNe LOTAFEA VRCRNi51iE FE S VALUATION FEE <br /> nves r no ounowc � <br /> — I <br /> NEIGHTLIMITRION NOOFOWELLING 5�2EOF0LOORI � <br /> 1IN11S plUN01NG � <br /> � <br /> OCCUP�NCV NO Of SIORiES OGCUPRNi IORU BASEMENi MEGH�NIf.AL � <br /> OROUP <br /> IIYES I I NO � <br /> nODI110NA1 i`LAN C�If.CK j <br /> FIRE�LARM REO'D RFASON i <br /> �_— <br /> OTMER � <br /> i <br /> FIRF.SPRINKIEC REOD RE�SON <br /> SiN[�IIIIOWG Sll(ICNA(iGE <br /> i <br /> TYPEOFf,pNST PIANSAPPPOVE00Y CITYOFEVERETT �Ilplif,WORKS <br /> LOCAL SALES --'— <br /> UAIE TAX CODE IS 3105 7oTAL <br />