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APPLICATI4A FOR CONSTRUC? �ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br />` 3200 CEDAR STREET• EVERETT,WA 98201 •259-8810 <br /> I I-1 DEMOLITION fl COMBINATION rl BUILDING fl MECHANICAL �f PLUMBING (l SIGN <br /> PROJECTADDRESS �Ov� �1/OKf�e ✓lv� �de��-li G1�0`� I8�0.3 <br /> / /�l ri <br /> OWNER M�IL�DOPESS Cltt IIP P11oNE <br /> `J ocQ� ,E �a���.a� 19DY' ►'1�e:lrae t�� E,e c���� W�t 3y� `I 3 68 <br /> TENANT MAILADD .SS QTY 21P CIIONE <br /> ARCNITECT OR OESIGNER MAII AODRESS Gltt lIP PHON[ <br /> GENER�LCONiR�G7G7 MAILADDRE55 G(v ZiP PHON[ STATEUCENSE• <br /> MECHANICAL CONTRACTOR MAIt ACORESS QN 7.IP PIIONF STATE LICFNSE• <br /> PLUMBING NiRRCTOR MRIL��DRE55 CILY ZIP PNONE STATEUCENSE• <br /> M1✓ — <br /> LONTRACT PRICE OF WORK <br /> HEATING SYSTEM: f i GAS �l ELECTRIC f l <br /> DESCRIBE WORR ANO SOII�RE FOOTAGE INVOLVED CONT�CT PGRSON ANO PHONE NO. <br /> � (/ �� <br /> � L'�� A.L /�.�6f'�LS�� <br /> � I HEREBY CERTIFY THAT I HAVE READ AND EXAMiNED THiS <br /> PROPOS�IIILDING APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> CF� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HERC-IN OR <br /> LEGALDESCRIPTIONOFVROPEPTYISNONNBELOWORRT7RCHTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> toT aiocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOfiIZ[D BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> FARCEI TA%I.D.NUMBER CONTRACTO LAW 1827 RCW AND 29620D WAC. <br /> CONSTRUCTION IO�N LENDER.�ODRE55.TEIEPHONE NUMBER <br /> x O� �' �u�c �/r/9� <br /> SIGNRTURE DR7F. <br /> CITY BUSINE55 UCENS[NO <br />� PLUMBIN6 MECHANICAL <br /> NO. TYPE OF fl%TURE OR ITEM FEE NO. TYPE OF EGUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDL�UNITS—H.P. ' <br /> BATHTUD ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> i <br /> UVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRY TRAV ; RANGE HOOD � <br /> CLOTNES WASHER � WATER HEATER �_ <br /> URINAL ' WOOD STOVE ' � <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNINGj � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERc � GASFIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE ' <br /> � GAS PIPING � <br /> i EXHAUST FAN � <br /> � ' <br /> i � <br /> � <br /> � ' <br /> SUB TOT.4L 5 � SUB TOTAL $ � <br /> PERMIT $ i PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSFTPACN AF.ARSFiPRCN SI�ESFTPACI( �IANCIIECNNIIMAfR /i �EP RECf:IPiNO <br /> L �)1�.�. <br /> usezor+e iornnen VACRNi51TE FEES VALUATION FE_ E r_ <br /> fIVES 11 NO � <br /> pUItOING � <br /> HEIGIIT LIMITATION NO OF UW@LLING 512E OF ALOG41 <br /> UNIfG plUM01NC ____ � <br /> _ i <br /> OCCVPANCY NO O�S�OnLLS OCCUPANIlOAO B�SEMENT MECHeNIG�I � <br /> GROUP — <br /> t1YE5 '1 NO <br /> �DD!IIONM.PI.�N G���CN �� <br /> FlRE�URM REOD RfRSOY -- <br /> i <br /> on�rn � <br /> � <br /> Fme srniNKi.cA nr:no nencor� � <br /> smc eun orvc sur+cimrc�e , <br /> rvrF or cor+s m nNs nrrnoveo or CITY OF EVERETT runur,woi�Ks � <br /> LOCAL SALES -- � I <br /> ��q�� TAX CODE IS 3105 TO7AL __ �_ <br />