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APPLICATIOrI FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> fl DEMOLITION fl COMBINATION fN BUILDING I-1 MECHANICAL �� PLUMBING �l SIGN <br /> PROJECT ADDRESS <br /> �g� � �� � <br /> OWNER M�I�AppqE55 CITY `� Zlp PHONE <br /> �UA�✓6 �. /�i9Y�rwIF 28/7 H�OoQR Wr9y F�IFPa71 9QZa/ �S9-l9�// <br /> TEN�NT MM�ADDRF.55 CITY li0 FNONE <br /> �HCHITCGTORDESIGNER M�II.�DOFE55 qTY p�p pNONE <br /> GENE GP+TR�GTOii MML nDDRE55 ���y lip p��pNE STqT[��CENSE� <br /> �,,,.� <br /> MECHANILALCONTRRCWF AIqI�qDDPE55 CIIY Z�p PNONE STATELICENSE� <br /> {'LUMBMGCONiR11GTOR M4ILADDRESS CITY p�p pNONE STATELICENSE� <br /> CONTRIIGT PMCE OF WORN <br /> ..r/JO HEA7ING SYSTEM: ( 1 GAS �l ELECTRIC �l <br /> pESCRIBE WMi1(�NO SOUARE POOT�GE INVOIVED CONT�Ci PERSON�ND PMONE NO <br /> �Ui1.O 3�0 SQuR2E �ao� � r <br /> R <br /> 1 HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> v�seouse ov eut�owc APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEWLOESCA�PTIONOFPROPEq}y(grypyyHBELOWOR�TUIGHTWOCOPIE57 �'�'ORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN �A <br /> tor Z2- o��K Oe O ^� ' 00 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> o� AUTHORITY TO VIOLATE OR CANCEL THE PqO�/1SION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> t I E" D /�/0� L PERFORMANCE OF CONSTRUCTION.THAT 1 qM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHIGH <br /> O60 —�-00 LUT 22. T6W N28iT e6l�7,Z� APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCEI T�%I D.MIMBER CONTRACTORS LAW 1827 RCW AND 296.200 Wqp. <br /> — — O — —. OCJ H� <br /> CONSTRUCTON LOAN IENDER.ADORESS.TEIEPHONE NlMBER X ��,�„�_ ����C. 9/�yS <br /> SIGN�TURE DATE <br /> CITY BU9NESS UCENSE N0. <br /> PL�M�N6 —�__� <br /> MECHANICAL <br /> NO. TYPE OF FlIRUqE Op ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET�TOILET) � /VC—A/HNDLGUNfTS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) � HEAT pUMP � <br /> SHOWER � UNIi HEAfERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP CLOTHES DRVERS � <br /> DISHWASHER 'JENTILATION FAN � <br /> LAUNDRY THAV ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL WOOD STOVE ' <br /> DRINKING FOUNTAIN ; METAL fIREPLACE(WOOD BURNING) ' <br /> FLOOR DRAIN � FIREPLACE INSERT(WODD BURNING) � <br /> BACKFLOW PREVENTERS ; GASFIREPLACE �� <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE �� <br /> ' GAS PIPING ' <br /> � E%HAUST FAN � <br /> , — � <br /> � � <br /> SUB TOTAL $ � SUB TOTAL $ � <br /> PERMIT $ PERMIT g � <br /> TOTALFEE E � TOTA�FEE E � <br /> FOR OFfICE USE ONLY: % '=.—�! <br /> fRONTSFTPACRr`� pF.ARSF.`ROK SIUESETBnC% pIANCUECKNUM9ER fE�/ RFCE�PTNO <br /> �Lf ��� <br /> V ",� /� <br /> use iot�aen vncavr sire " FEES VALUATION FE� <br /> ��—I � /`l000 ��YES �� � <br /> 8�����N� <br /> NEIGMTLIMIIRION / NN11WOWELLING 512EO�BLIX:R1 ��/� � i�,fl <br /> � � �C�( K PLUMPING "V <br /> OGGUP�NCY NO OfS10RiE5 OGCUP�NTLURO RSEMENT � <br /> f.f1011P � Mff,NRNICAL � <br /> IIYES tt NO <br /> �IRE�Uf1M(iCO�D tilASOY �pD11104A1 PIAN CN[CK �� <br /> OTHEii � <br /> FlPF.S��INKIFRnEOD RFFSON ' � � �� <br /> /D SiN[AlIIl01NC SURCNRRCE � <br /> � <br /> rrrForr,oNcr �inNsnrrovner CITYOFEVERETT rirpiir,wonKs ' <br /> �j , / LOCAL SALES --'� <br /> ��L �� onie 9�q S TAX CODE IS 3105 TOTAL <br /> /DS- '� <br />