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APPLICATIOri FOR CONSTRUCTi�ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •759-8810 <br /> fl DEMOLITION COMBINATION I, BUILDING f-1 MECHANICAL �� PLUMBING fl SIGN <br /> PRO.+ECT ADDRESS /��7 ��/N�� ;— <br /> o,N,E��� �t�e..c�- —S�.bi �'15�-,`��tc. )8�1 19+hZ���W��� ���� ae� a90 -145�, <br /> TEN�� MqIIqODRF55 CITY Z�P P��ONE <br /> ARCNRECT OR�ESIGNER MAIL RUDRESS Cltt IIP PHONE <br /> GENERAIGONTRnCTOR MAILAGDRG55 CI1V 21P PHONG 51AiGIIC@NSE• <br /> IAECHPNICALCONTR�CTOR N�AIIpDDRE55 Cltt ZIP PHONE STATEIJCENSE� <br /> PLUMBINGCON7RnCTOR MAIL�ODRE55 CITY ZIP P��ONE STATELICENSE• <br /> GONTR�CT PRICE OF WORN <br /> HEATING SYSTEM: f AS �l ELECTRIC I-1 <br /> DESCRIBE WORK ANO SOU�R FOO � INVOLVED //� LONTr1CT FER50 AND MONE <br /> '7 11 � <br /> p� / /\ <br /> � � <br /> ���C G]�n/ I /�/� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROPOSEDUSE OF BUILDING PROVISIONS OF L��WS AND ORDINANCES GOVERNING TH�S TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�lOE2SCRIPTIONOFPROPER,TY��SHGOWNBELOWIXIATTACHTYOCOPI NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or O ! � �_e�ocK�L oF �-� Au• � AUiHORITY TO VIOLATE OFl CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � �� � S. �-S� OF lS�" I PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK POR WHICH <br /> /.1 D� .j�,,,'�- /J]�7�'�� •�� ' b -b �1 APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> l-0T' ��ta 'r-J CONTRAC70RS W 1B2 C A 296200�AC. <br /> P� ELTA%I.D.NU BER <br /> cn�-ra ,�# 4387���II o - cJ^ a_ S <br /> CONSTR11GilON IOAN lENOER.RDORESS.TELEPMONE NUMBER x <br /> SIGN URE OATE <br /> /� i /� GITVBUSIN�SSLICENSLNO. <br /> PLUMBING MEC +ANICAC <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO _ TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � � A�—AAINDLG UNfTS—H.P. ' <br /> BATHTUB W 1("' ' ' FORCEDAIRSYSTEMS—B.T.U. M E.A. ; <br /> i <br /> LAVATORY(WASH BASIN) T HEAT PUMP � <br /> SHOWER ' UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN ' _ <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER ' <br /> URINAL ' WOOD STOVE ' <br /> ORINKING FOUNTAIN � METAL FIFEPLACE(WOOD BURNING) � <br /> FLOOR DRAIN FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE ' <br /> GAS PIPING , <br /> � <br /> ; EXHAUST FAN � <br /> � ' <br /> SUB TOTAL S ; SUB TOTAL $ ; <br /> PERMIT 5 � PERMIT 5 � <br /> TOTALFEE 5 ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> {'RONT SETPALN � PEAR$FTBACK S�DE SETBAC�( �LAN CIIGCN UM�FR FEG RECEIPT NO. <br /> 2o d S ��"��'� <br /> usezoy� iornaen V�CnNISIIE FEES VALUATION FEE <br /> F- —Z �71�� es i� No ounnwc '70 3S6 7/ � � 1 <br /> IIEIGHT I�MITATION� NO OF UWELIING SIZE OF BLDU� `N i <br /> UNIIS /Zy3 S �vG f' rtuMei�+c __�.'� ' � 1�' <br /> I sr G.an„�e ---� <br /> , <br /> OCGUPANCY NO 0�$tORiES OCCUPANf LOAD BASEMENi MEG��ANICAL �'=� � �- <br /> cnour - <br /> 3 J I ���es �✓ � <br /> A�DIIIpN�I.PL�N CHF.CK ' <br /> PIRE ALARM AEO�O REAFON —+-- <br /> O1NER <br /> � <br /> PIRF.$PIiINKIERPFO'D REA50'1 <br /> STATEOIIIIDING5URC11nfIGE �� � <br /> _ � . <br /> rmeorr,aNsr vinHsarrrovFnnv CITYOFEVERETT runnr,wonKs ,.�;"' � � � <br /> �� TAX CODE S 3 OS TO7AL � r� 'n^ <br /> �-� ontE � S <br />