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� � ' <br /> APPLICATIOrI FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-6810 <br /> f7 DEMOLITION fl COMBINATION (-1 BUILDING I-1 MECHANICAL «" PLUMBING f 1 SIGN <br /> PROJECTADDRESS �/2 I1 ��� �I E1� l�� EVC4zGT� <br /> OWNER MNL�ODRE55 CITY 21P P110NE <br /> �-la r��e.sr�� At�r—�A-rt��s �i � — o v g Cv <br /> IEN�NT �AIIRDORE55 CITY ZIP PNONE <br /> ARCHITF.CT OR OESIGNER MRII AUORE55 Cltt 71P PlIONF. <br /> GENERPLCONTR�CTOR MRILpODRE55 CIIV ZIP PIIONE 514TEI.ICGNSE� <br /> MECH�NICRLLONiRAC70R MpILADDRE55 CITY ZIP PIIONE STATF.LICF.NSE� <br /> PWMBINGCONTR�f,TOR MRILAU�RE55 CITY ZIP PHONE STATELICENSE• <br /> PT U C� 1� <br /> GONTP�CT PRICE OF WORR <br /> HEATING SYSTEM: fl GAS �I ELECTRIC f� _ <br /> OESCRIBE WORK AN�$OIIPRE FOOUGE INVOLYED CONTACT PERSON ANO PHONE NO <br /> n C 6 ,� D n.I n� , <br /> I � // I HEF'�BV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> C�O /1 P T7 I/� � C- !1�'�� �r^-�— APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALl <br /> vaovos USE OF BUILDING pROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> IEG�LDFSCRIPTIONOFPROPERTY�SHOWNBELOWORRTTRCHTNVCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior etocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE I COMPLV WITH THE STATE <br /> PMCEL TNf I.D.NUMBER CONTRACTORS LAW 18.27 CW ND 00 WAC. <br /> CONSTRUCTION IOAN LENDER.ADDRE55.TELEPHONE NUMPER k •�� � a � V/2'4��� <br /> SIGN�TURE DAIE <br /> CITY BUSINE55 LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF flXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATERCLOSET�TOILET) � A/C—A/HNDLGUNfTS—H.P. ' <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. ; <br /> LAVATOHY(WASH BASIN) � HEAT PUMP ' <br /> SHOWER ' UNITHEATEiiS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP � CLOTHES DRVERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CIOTHES WASHER � WATER HEATER ' <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN FIFEPLACE INSERT(WOOD BURNING) ' <br /> ' GAS FIREPLACE � <br /> BACKFLOW PREVENTERS � <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE <br /> GAS PIPING <br /> i EXHAUSTFAN ' <br /> � ' <br /> SUB TOTAL 8 ; SUB TOTAL $ � <br /> PERMIT S i PERMIT S �_ <br /> TO?ALFEE 3 � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: � <br /> FPONTSFTPRCN RERRSF.TOACN SIDESELpnCN �lANC11ECKNUA1pfR �EF �Ef.E1PiN0 <br /> usezoNe ioreaen VACANISITE FEES VALUATION FEE <br /> I I YES �� M1O BUIL�IHG i <br /> MEIGHT UMITATION NO OF OWEIUNG SIZE Of BIDGT i <br /> UNIfS PWMOING � <br /> i <br /> OGGUVANCY NO Ot510RiE5 OCCUPRNTLO.D BRSEMENT M[CHRNICAL � <br /> � <br /> [ROUP — — <br /> fl\ES �� NO <br /> A�OI110NAI.PLAN CNECK <br /> FlRE ALARM PEO'I1 RFASON — <br /> 0711ER <br /> FIRFS�'�INRIF.RRF.O� �FASO4 <br /> $Tp1E 1111IlDMG SURCIIMGE <br /> tmEorr,oNst rinNsnrrrovenAr CITY OF EVERETT runi�r,wones <br /> LOCAL SALES — � <br /> ��qiE TAX CODE IS 3105 TOTAL '_ <br />