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APPLICAT14�1 FOR CONSTRUCT�ON PERMlT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 982U1 •259-8810 <br /> f� DEMOLITION fl COMBINATION f-I BUILDING i-1 MECHANICAL � 1 PLUMBING fl SIGN <br /> PROJECT ADDRESS <br /> �iz� r✓1�,,�1� <br /> OWN1ER(y� . I M�ILII�1 � r.l./IG.. C(I'G/V f /C/ ZOI r��V�/�� / —d VS! <br /> J�-1 1 I l� I !�I C <br /> TENANT M�ILADORE55 CITv 21P PIIONE <br /> � ,� <br /> ARCHITEGTORDESIGNER MnILADDRE55 CITY 71P PMONE <br /> GENEMILONTOAGTOR MAILRDORE55 C17V zIP PIIONC SiAiELICENSE• <br /> MECHANIGL CONiR4CTOR MPIL RDORESS GTV l.IP PHONE SiATE LICEN$E• <br /> PLUMBINGCONTRACiOR MAIL�ODRESS Cltt 21P pHONE SiA1ELICENSE• <br /> �i <br /> GONTiUGT PRICE OF WORK <br /> HEATING SYSTEM: f l GAS fl ELECTRIC fl <br /> DESCRIBE WOAK ANO SQII.\RE FOOT�GE INVOLVED CONTFCT VERSON AND PNONC:NO. <br /> 'I�G <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSEDUSEOF B1111.DING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.AlL I <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHEH SPECIFIED HEREIN OR �� <br /> LEG�LDESCRIPTIONOFPROPERTY�SHOWNBELOWORATfACHTWOCOMES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 70 GIVE . <br /> wr e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY � <br /> OTHER STATE OR LOCAI.lAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WNICH I <br /> APPLICATiUN IS MADE AND 1 COMPLV WITH THE STATE <br /> PARCEL iA%I.D.NUMBER CONTRA O W 1827 RCW AND 296200 WAC. <br /> CONSTRULTIONLOANLENDLR.AODRESS.fELEPHONENUMBER x IZ U �S I�I <br /> __ D�TE i <br /> CITY BUSINESS LICENSE N0. I <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF fll(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLO UNITS—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; �� <br /> LAVATORY(WASH BASIN) i HEAT PUMP � � <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP ; CLOTHES DRVERS � , <br /> DISHWASHER VENTILATION FAN � I <br /> LAUNDRY TRAY ; pANGE HOOD ; � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL � WOOD STOVE ' I <br /> DRINKING FOUNTAIN ; METAL flFEPLACE(WOOD BURNING) � � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � �. <br /> BACKFLOW PREVENTERS ; GASFIREPLACE ; � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � ��, <br /> ' GAS PIPING I <br /> i EXHAUST FAN � � <br /> ' , I� � <br /> ' I <br /> � � i <br /> SUB TOTAL S ; SUB TOTAL S ' li <br /> � <br /> PERMIT E � PERMIT E /S� � <br /> TOTAL FEE S ' TOTAL FEE E ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETPACK RERR SETBRCK SIDE SETB�CK PU�I CIIELK NUMBF.R fEE REGEIPT NO <br /> ,�al�Co <br /> u5e iONe ioi naen V�C�Nf SITE FEES VALUATION FEE <br /> iives roNo ounowc � <br /> I <br /> HEIGIIT LIMIT�TION NO.OF DWELUNG SIZE OF BIDGT � <br /> pNIIS pLUMpMG � ' <br /> OCCUPANCY NO Ot SIORIES OCCUPAN!1.04D BASEMENT - �I =__ <br /> OROVP MECIIANICAL <br /> IlYES I1 NO <br /> FIREIIURMRECD RFRSOY �DO1110NAI.PI.ANCHCCK <br /> i <br /> OIIIEP <br /> FIRFSPRINKLERREO'D �FnSO4 <br /> STAIE Al11lDIVG SI1RC11�RGE � <br /> TmForr,or+sr— rinNsnrrnoveoav CITYOFEVERETT �'�����f.�VORNS <br /> LOCAL SALES �— <br /> ,.q,E TAX CODE IS 3105 iorA� � <br />