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APPLICATIOrI FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> DEMOLITION fl COMBINATION fl BUILDING fl MECHANICAL rl PLUMBING f l SIGN <br /> PROJECT ADDRESS <br /> "Jo 31 �i�ii ��iii- 17�•i�v<� � Uri�� t/ GI.,',q, 95�� .3 <br /> ��ER MnILADDRE55 Citt Z�P PNON[ <br /> � �td ���, k��,, d���i�,.., ��q�,s� ���, ��,: ��,��«� ; �� � ���� - <br /> i r � r,� .Slt� �,<<�, ..� � ��;� 9s�t9.� � s-� ��v3 <br /> IENANT q INAILApORE55 CITV ZIP FNONE � <br /> 1` l �'7� <br /> PRCNITF.CTONOESIGNER lApILpDORE55 �ItV 71P PHONE <br /> GENE/p/p�LC�}ON�if1�Gi/0�/f�/ MAIL9pI)PE�S � CIIY 71P PiION[ $tATE IICENSE• <br /> —/U i K.C� i 'Il���'\ �//.�L(�/ � <br /> MECNpNICAL CONTR4CTOB MnIL AODRF.55 Cltt ZIP PIION[ 574TE UCENSE� <br /> �tUMBINGCONiRAf,iOR MA�Lr1DURE55 QtY ZIP PNONE STAIEI.ICENSE� <br /> CONTRACT pRICE OP WOON <br /> HEATING SYSTEM: f 1 GAS �l EIECTRIC I l <br /> OESCRIDE WORK AND SOUARE FOOTAGE INVOIVED CONTACT PERSON�ND PIIONE NO <br /> !M D S� <br /> I HEREBY CEFTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILUING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OF <br /> LEGPL�ESCRIPTIIXJOFPROPERTY�SHOWNBELOWORpTTACHTWOCOPIES� , � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or �•� BLOCK�or � ' � NI�I�S D i✓ l AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> GTHER 3TATE OR LOCAI.LAW REGULATWG CONSTRUCTION OR THE <br /> n+ �r rr�rd.� ! r�� Z�aI /n �� t� /��< h-;, � 7(. . �� pERFORMANCE OF CONSTRUCTION.THAT I AM AU7HOR¢ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> I��Gol�JS o � �S�t i �� , �;� I(/,q • APPIICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCE TA f IA. UMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> � U � . � , � <br /> CONSTqUCT10NLO�NLENOER,ADDRE55.iElEPHONENl1MBER x_C/'L (t.("�t�Cf /:�7u �1�,��(c!�'/.�,: ��—�� — �S <br /> SIGNATIIRE �� � ONE <br /> CIiV�USME55 LICGNSC hJ <br /> PLUMBING MECFiANICAL <br /> NO. TYPE OF fl%TURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATERCLOSET(TO�LET) � A/C—A/HNDLGUNITS—H.P. � <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) i HEAT PUMP , <br /> SHOWER � UNIT HEATERS—B.T,U. M <br /> KITCHEN SINK 8 DISP ; CIOTHE5 DRYERS ; <br /> DISHWASHER VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD ' <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL � WOOD STOVE — � <br /> DRINKING FOUNTAIN ; METAL FIREPLACE(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 /> � EXHAUST FAN � <br /> � � <br /> i � <br /> SUB TOTAL S SUB TOTAL 5 ; <br /> PERMIT S � PERMIT S � <br /> TOTALFEE 5 � TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FRONTSETPALK PFMSFTft4CN SIDESETBnCN PlANC11ECNNUMtl[R fC[ �Gf.&IPLNO <br /> O�7 <br /> usezor+e wrnaen wenNtsitr FEES VALUATION FEE <br /> nves i; rvo nwion�c � � <br /> MEIGIIT LIMITATION NO OF pWEIUNG SRE OP OLDGRI i <br /> UNIIS <br /> nwnmiNc <br /> --+— <br /> OCCUPPNCV NO Oi SIOm[5 OCCUPANT LOAD Bn$EME4T � <br /> Gf10UP MECIIANIC�I � <br /> I1vE5 II NO — — � <br /> FlREAIAfiMREOD t1f�SON ApDI110NA1.t'I.�NCHF.CK <br /> __�_— <br /> OTMFR � <br /> FIRESPRINNIFRRFO�II RFASON — <br /> 9NE fll➢IDMG SUf1CH�fiGE i <br /> trreorr,orusr r�nNsnrrnovenov CITYOFEVERETT runnr.wonKs <br /> IOCAL SALES — -- ---- <br /> ��q�E TAX CODE IS 3105 TOTAL <br />