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APPLICATIOr�I FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOUTION �l COMBINATION f1 BUILDING I-1 MECHANICAL f� PLUMBING fl SIGN <br /> � PROJECT ADDRE S <br /> 4 � r �c� �o <br /> OWNER �� M�IL�DpiE55 qtY 21P PHONE <br /> � �L_ca.r A e ///e.r�e.� '�61 a /�i.? °�rs'4J i(✓n��mo q�/��1 1�'03 6 6 70 /G��` <br /> TENANT MAILAODRE55 dTY ZIP PNONE <br /> �RCHITECTORDESIGNER MRII.A�DRE55 GITV ZIP f'NONF. <br /> G ALGON RGTOR ' MAII�DURE55 QLV ZIP PHON[ STAi[IICENSE• <br /> �' ��MCi1JYQqS <br /> Y6.zo t�1 cf r�tJ ���Hc✓ved �ae 9'dQ36 6To/6L� ToNVJC�MoG.7/is�' <br /> MECNANICAL CONTRACTOR M�IL RDDRE55 �GITY 21P i�110NE STRTE LICFNSE� <br /> �"7 3 <br /> PLUMBINGCONTRRCTOR M4ILRDDRE55 CITY ZIP PHONE STATELILENSE� <br /> �Q °F'�— 1'�6w �mv.�l rooFtne� s�uwres HEATING SYSTEM: f� GAS �7 ELECTRIC fl <br /> Y DE RIBE WOR AN�SOVAqE FOOT�Gc INVOLVEO CONT�CT PERSON RND PNONE N0. <br /> lR yz /Q/toe a <br /> 9� c _ <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � rnoro D USE OF Bl11LDING PROVISIONS OF LAWS AND ORDIN..NCES GOVERNING THIS TVPE OF <br /> �If� L WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> IEGALDESCRIPTIONOFPROPERTv1�OWNBELOWOR�TiACHTWOCOPIES� NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAI LAW REGULATIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOHM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTiVt I.D.NUMBER {�r� CONTRA TORS W 18.27 RCW AND 296.200 WAC. <br /> � /S� �J" �S ��Q� �� � <br /> CONSTRUCTION LOAN LENDEq,PDDNESS.TEIEI'NONE NUMBER � �_ / / / �� <br /> SIG T D V� � <br /> CITY BUS�NE55 LICENSE NO. <br /> PLUMBINa MECHANICAL <br /> NO. TYPE OF FlXTURE 4R ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—AMNDLGUNITS—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRVERS i <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDHY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> . DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS � GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE ' <br /> GAS PIPING ' <br /> ' EXHAUSTFAN � <br /> � ' <br /> 1 ' <br /> � ' <br /> � <br />, , � <br /> SUB TOTAi S ' SUB TOTAL £ � <br /> i <br /> PERMIT $ � PEFlMIT $ � <br /> TOTALFEE S � TOTALfEE $ ' <br /> FOR OFFICE USE ONLY: — <br /> FRONT SETPRCK PEAR SFTBIIGK SIDE SETBRCK PI�N Q1EC MAER FEE RECF.IPT NO. <br /> 3 <br /> uSezoNe ioTnaen VRCRNLSITF FEES VALUATION FEE <br /> f1YE5 I1 NO ]/v"l � i <br /> BUIIDINf. c/[N � <br />. HEIGNT UMIT�710N NO.OF OWELIING SRE OF 7lDOR1 � <br /> UN175 p�pMBING <br /> � <br /> OCCUP�NCV NO Of S�OFiES OCCUPRNT LO�D BRSEMENT � <br /> MFCII�NIf.AL i <br /> CROUP - — <br /> f1VE5 I1 NO � <br /> PULIiIONAI PL�N CNF.GK � <br /> FIRE�LARMREO[1 fifrt50' � — <br /> i <br /> pT11EP <br /> FIRFSPRINRIERREO'D RFAFON —� <br /> STAIE OUItDMG SURCHARGE �� <br /> TYPEOFf,ONST �L�NSAPPROVEnBV CITYOFEVERETT runucwonKs ' <br /> 1�� <br /> IOCALSALES <br /> unie TAX CODE IS 3105 TOTAL � J '�� <br />