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APPLICATIOrN FOR COHISTRUC7 .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259-8810 <br /> fl DEMOLITION fl COMBINATION fl BUILDING f� MECHANICAL �� PLUMBING fl SIGN <br /> PROJECTADDRESS Iv�O� I�"���Z�Af�J �V�NGtC r=- <br /> ��i '" . I <br /> ��ER M�ILAODRE55 Cltt IIP pHONE <br /> Al Q.J F�.i(.�;�i � �/n,,�=s �-T� � k� Mi9P[ru����� L.4.��`[�Hon��\5t/c//�9PJ?/ 77� ����97 <br /> 7ENMlT M�ILA ESS �— IIP P ONE <br /> �'1C l�S �7.71/t� <br /> ARLHRECTOROESIGNER MAiI�DURE55 GIIY ZIP PNONE <br /> �lr�c AS .tlE�r)lIF <br /> GENEP�LCONTMCTOR M�ILADDRE55 �IIV 11P pHONE STATELICENSE� <br /> �..t�c...i /�4r�N� 17�( IZIS� St S�AI I Y,.��n.��oD ir�iR �Q5-3� �Eni��4 T�37Du <br /> ME HANICA�C M�ILAODRESS CITV ZIi" PHONE SiATEL�CENSE� <br /> �Q_ ���.�bint/: �4ZS �Sf lU� �Ji�Un�GTvA/ ��j7�'(�IZO� $cAQ?ev�OITL <br /> PLt1MBINGCONTRAGTOR M111U PE59 an• nr �� PHON—E r SiATELIC NSE� <br /> �O <br /> x�.�2 <br /> CONTRACT p�WpRN <br /> HEATING SYSTEM: �Q GAS f-1 ELECTRIC I-1 <br /> OESCRIBE WORN�ND SOUARE FOOTAGE INVOLVED CONTACT PERSONAN�P110N/Fy'O <br /> ! � l.,l.. N�t <br /> as � � � I HEPEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> rnaroseo use oF auadr+e APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ,� G � PROVISIONS OF LAWS AND OROINANCES GOVERNING THIS TYPE OF <br /> �� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN (?i <br /> �c�ioeSfi IP110NOFPROPERTY�SHOWNBELOWOR�A�nvoc ie/s�� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � 3 �%� AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> LOT BLOCK OF <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> 5r r_ ���G_11 � p(,,.d _ PERPORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZEO BY THE <br /> OWNER UF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCEL hV(I.D.MIMBER CONTRACTORS LAW 18 ? W AND 296.200 WAC. <br /> CONSTMICTION LO�N LENDER,�DORE55.1ELEP110NE NUMBER IV"Z' � <br /> IGNA U O�iE <br /> � C f V t w CITY BUSINESS LICENSE NO. <br /> PLU INfi MECHANICAL <br /> NO. TYPE OF Fl7fTURE OR iTEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATERCLOSET(TOILEn � A/C—A/HNDL6liNITS—H.P. ' <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(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 /> CLOTkES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> ORINKING FOUNTAIN � — METAL FIREPLACE(WOOD BURNING) � <br /> FLOOP DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � — GAS RANGE � <br /> ' GAS PIPING ' <br /> i EXHAUSTFAN � <br /> � � <br /> i � <br /> SUB TOTAL S ; SUB TOTAL $ ; <br /> PERMIT $ � PEFMIT $ i <br /> TOTALFEE E ' TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> F{10Nf SEIAACN AEAR SETBACK SIDE SETB�CN PIAN CIIECK lIMlIFII FEF ✓ RECEIPT NO. <br /> 20 !v" " � ��5/ �r-, <br /> use zoNe IOTAFEA vecnNt sre FEES VALUATION FEE <br /> _ �� � 000 i.rGes n r+o owioiNc OS Z ' �y � • <br /> Hk16NT UMIi11TION r NO OF DWEILING SIIE OF BLD�/ti i <br /> �JQ� UNITS f / ff C/V/NL '{' p1.UMpING 7 7 i <br /> vu 9�S Annyc <br /> OCCUPIINCY NO OI SiOtiiES OCCUP�Ni LO�D BnSEMENT D i <br /> GRWP MEC114NIC�L <br /> i <br /> n-s �-� �z �v A �,YES � o <br /> FIRE�URM REOD REASON ADDI110N�L PL�N G�If.CK <br /> � <br /> qTMER � <br /> fIRF.SPRINKIEARF.OD REASON i <br /> STAIE PUIIOMG SURC114^;E � �U <br /> rvreorcoNsr PinNsnrrn�vepav CITYOFEVERETT runiir,wones !?(�; — <br /> �/�"f LOCAL SALES <br /> �/�/ oeTE /0 3i I7'S TAX CODE IS 3105 707AL � J21 — <br />