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� APPLICATIO.� FOR CONSTRUCT„iN PERMIT <br /> l CITY OF EVERETT• BUILDING DIVISION <br /> C3200 CEDAR STREET• EVERFTT, WA 98201 •259-8Gt0 <br /> fl DEMOLITION I l COMBINATION 11 BUILDING �l MECHANICAL f l PLUMBING f� SIGN <br /> PROJECT ADDRESS <br /> 12�3 /}�fa /c-'- _S � <br />� OWNER MAILADDRE55 Itt ZIP PHONG <br />� �I�A.TAN �i+Ami i�a3mApt,�st ���ee�i- gFz� , 33�- a3�9 <br /> TENANT MNLApDRE55 CIIY Z:P PHONE <br />. ARCHITECTOfi0E51GNER AIAILADDRESS CITY ZiP PMONE <br /> � GENER CONTRACTOR MhILAODREaS QiY ZIP PHOYE STAiBLIC[NSEM <br /> �I.tJ I`-�� <br /> A!ECHANICAL CONTR�CTOR MAIL AD�RE55 CITY ZIP PMONE STAiE LICGNSE v <br /> PLUMBINGCONTRACTOP MAILAO�RE55 CITY ZIP PHOK" STFTELICENSE• <br /> CONTRRCT PRILE OF WORN � <br /> / ''� �- HEATING SYSTEM: f 1 GAS fN�ELECTRIC �l <br /> DESCRIBE WORK ANO S�UME OOTAGE INVOLVED CONTACt PERSON ANO PHONE N0. <br /> t <br /> '. b ' <br /> � � � I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSE�USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AIJD CORRECT.,�LL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALOFSGRIPTIONOFPROPEHTY�SH0IYNBEIOWORATTACHTW ories� NOT. THE GRl�NTING OF A PERMIT DUES NOT PRESUME TO GIVE <br /> ��or I(� I�BLOCK or�� I AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEfiFORMi.NCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PEP.FORM �:HE WORK FOR WHICH <br /> APPLICATION IS MADE AND � COMPLY WITH THE STATE <br /> � anace�rn 1 D.5nN(UMBER r/� CONTPACTORS LAW 18.27 RCW AND 295200 WAC. <br /> CONSTA�TIONL��E�R.PORE55 ELEPHON�ER� <br /> x—�L�.II-0..�,�� �`S� 9� <br /> SIGNAtURE � DA1E <br /> CITv AUSINESS LICENSG NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TVPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � � <br /> � VATORY(WASH BASIN) � HEAT PUMP , <br /> S WER � IT HEATERS—B.T.U. M � <br /> KITC N SINK 8 DISP i CL HES DRYERS ' <br /> i <br /> DISHW HER � VENTIL TION FAN � <br /> LAUNDR TRAY ; RANGE H OD � <br /> CLOTHES SHER � WATER HEA R , <br /> URINAL � WOOD STOVE � <br /> DRINKING FOU TAIN ; METAL FIREPLAC WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLAC;E INSERT OOD BURNING) � <br /> BACKFLOW PREVE TERS ; GAS FIREPIACE ' <br /> SINK(SERVICE—BA ETC.) � GAS RANGE � <br /> � <br /> GAS PIPING <br /> ��- A � � / EXHAUSTFAN � ; <br /> S J C 'L�t �+'+ ' <br /> � , <br /> � , <br /> � , <br /> SUB TOTAL 5 ; SUA TOTAL $ <br /> i <br /> PERMIT $ , PERMIT S i <br /> TOTAL FEE 5 � TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSFTjiACK__/ Rf:AR5GT04C� / SIDESEIDnCK�/ PLANCNECNNUMf1f� FGE� . /, _— RFCEI�Np.n�� <br /> N <br /> /_/_ U � / <br /> S tit�t I � � � <br /> usE� � i.otnnen vncnrvtsrte PEES VALUATION FEE <br /> � nves n No /J <br /> �UILUING 'ZI L ZJ O <br /> HEIGHT�IMIiAT10N / NO.OFDWE�LING 511EOFOLDGRI. <br /> UN17S <br /> 4 ZZ S� P(� PLIIMDING �g� <br /> OCCUPANCV NO OPSi0PIE5 OCCUP�NTlO�� BASEMENT i <br /> G U� � 4 �'7YES � M1IEQ/ANICAI f� i <br /> �J <br /> � <br /> FIREALAAMREOD R[ASON AOOITIONALPLANCMECN � 7n <br /> No � � <br /> a,���� � <br /> FIRE SPRINNLLR RBO'D RE450N <br /> , <br /> i <br /> N� STATE OUIL�ING SURCHARGG //�.-", <br /> TVPEOFCONST P�ANSFPPROVEOOY i <br /> J L CITY OF EVERETT rueur,wonac � <br /> Y � �-r LOCAL SALES <br /> onre S �j TAX CODE IS 3105 T!?T.:L 1 i ; �� <br />