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APPLICATI�..� FOR CONSTRUC7 .ON PERMIT <br /> CITY OF EVERETT • BUILDING DIVISION <br /> 3200 CEDAR STREET• EVEREIT, WA 98201 •259-8810 <br /> fl DEMOUTION I� COMBINATION fvr BUILDING f� MECHANICAL f� PLUMBING fl SIGN <br /> PROJECT ADDRESS <br /> 7� 7-9 �P,s���c��e.� �� G``�er-err �.o. 9B� 3 <br /> OWtlER/ MFILAOURE55 � Cltt 21P PHONE <br /> o✓oP� �l �Oil �i9«'G�(ii �d�YGr� �f�•4 9'�j`l�3 35 3� 7jZGl <br /> •�VANT MAIL�D�RF55 QiY 21P PIIONE <br /> PR�IIRFCTOPDESIGNER MAILA��RESS Gltt 71P PMONE <br /> GENERALCONTRAGIDF MnILPDORESS CIiV ZIP PIIONE STATELICENSE• <br /> pw �l�r S�4Mv !� S ��0�� <br /> IAECNANICALCONTR�CIOR UAIIA�DRE55 CIN ZIP PHONE STATEUCENSEi <br /> PWMBINGCONTR�CTOR MAIL��ORESS CIN ZIP PHONE STATELICENSE� <br /> CONiRRCT PRICE OF WOBN <br /> HEATING SYSTEM: I_] GAS ❑ ELECTRIC f_l <br /> DESCI�I��WORK AND. �ARE FOO�GE��0��0 ��t CO4TACT PERSON AN�PNONE N0. C �; S y _` � <br /> q� L <br /> `f L W Li: .J <br /> ,S�r' G- CiP� !d�a"ZO� � � Z9� <br /> I HEREBV CE9TIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROP(1 EDUSEOFBUILOING � 1 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �O�✓`G!/� �•% �// WORK WILL BE COMPIIED WITH WHETHEFi SPECIF�ED HEREIN OR <br /> LEGRLDESCRIPTIO OFPROPERTV(SHOWNBELOWsU�q ATfACMT1VOGOPIE5) NOT, THE GflANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or�e�ocK�oF N '�GY O�/� AUTHORITY TO VIOLATE OF CANCEL THE PROVISION OF ANY <br /> �y OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ��G7 • / � �Y j PERFORMANCE OF CONSTRUCTIOV.THPT I AM AUTHORRED BY THE <br /> OWNER OF THIS PROPEHTY TO PERFO�iM THE WORK FOR WHICH <br /> �• 8O� 0�' ? APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND?•.u.200 WAC. <br /> PAR�E� ��UMB�O� �O/� r���� <br /> ✓ / /' <br /> CONSiRl1CT10N LORN I.ENDEF.ADDRE55,TELEPNONE NUMBER x .�l� ' 1�� ` S <br /> URE DATE <br /> CITV BUSME55 LICFNSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCEO AIR SYSTEMS—B.T.U. M E.A. ' <br /> � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNITHEATERS—B.T,U. M ' <br /> KITCHEN SINK&DISP i CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN �' <br /> LAUNDRY 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 i <br /> SINK(SEFVICE—BAR. ETC.) GAS RANGE ' <br /> � GAS PIPING � <br /> ; EXHAUSTFAN � <br /> � <br /> � ' <br /> SUB TOTAL 5 ' SUB TOTAL 5 ; <br /> � <br /> PERMIT 5 � PERMIT S � <br /> TOTALFEE 5 ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONi SETORCN REAR SETAA� SI�E SETBACK PtAN CNBCK Nl1AN7ER ` FEE _ � AECEIPT NO.n <br /> i i � � !/ <br /> use zor+e LOTAPEA vncnrvr SitE FEES VALUATION FEE <br /> . nres n No OUIlU1N6 � j`i ) <br /> HEIGHTUMITATION, NO.OF�WRLING SIZEOFBLDG�TL � <br /> � UMTS n�� �`C PWMDING � <br /> � � i <br /> OCGUPANCY NO OFSiPRIES OCCUPANTLOAD BASEMENT MECM�NICAL � <br /> GROUP � <br /> N ❑YES , NO � <br /> A��ITIONAI.PLA4 CNECK , <br /> FIRE 4lARM RE00 REASON ' <br /> i <br /> OTH@R i <br /> FIRE SPRINKLER REO'0 REASON i � <br /> STATE OUII�ING SURLIIARGE �7 �/ <br /> _'�.J... <br /> TYPEOFCONST PIANSAPPf10VED0Y CITYOFEVERETT PUBIICWORKS �- <br /> � I� LOCAL SALES —' <br /> ��-!J onre (� �l� +s TAX CODE IS 3105 TOTAL � �t`7 <br />