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APPLICATIOrI FOR CONST'RUCT�JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOLITION �l COMBINATION Il BUILDING f-1 MECHANICAL �T PLUMBING f1 SIGN <br /> PROJECT ADDRESS <br /> �'3 z`7 ir'�Gr=n,���T �'�yE' ��'1�t=��,=:r �_ .Fl - �r3 zc� <br /> OWNEP � MnIL�"D�DRE55 CITV IIP PHONG � <br /> �XJ�7� (�f{�-'�j�� �I})-�1U i-n I fl r.� ���1�'�f' '� �' FJ�l.I A' 3�%"'Z ���–CP <br /> 1EN11NT MMIT�ORFS$ Cltt 21P PNONE <br /> �%`\'+�-1-T ��C �t�'SliLCS <br /> ARCNIiFGT OF OESIGNER M�II.pDURE55 Gltt IIP PIION[ <br /> GENERPLCONiPRCTqi MRILADDRE55 CIIY ZIP PIION[ $IATLUCENSEr <br /> O\���\ <br /> MFCHANICRLCONi4ACTOR MAILA��RE55 CITV ZIP PNONE STATELICENSE� <br /> PLUMBINGCONIP\CTOR MAI�A RI55 ' Cltt ZIP '110NE STATELICEPSF.• <br /> � <br /> GONTpqCT PRICE OF WORK — — <br /> HEATING SYSTEM: I GAS �l ELECTRIC f l <br /> OESCfi1BEWOPNAHU, UA �G INVOLVE �O�yip"TPERSONp1��P110NEn��� ��S �Z�S� C�N� <br /> �� /1 <br /> VV UV <br /> Pi��N ,,n,v�F� ,� . �'�- �n.�'s � r.,�- n - t.�rZ(C_ � � <br /> �u�,�� Oi �' �. 7J 5 — C � � I HEREBV CERTIFY THAT I HAVE READ AND EXAM�NED THIS <br /> vnoPoseouse oF euaoiNc , APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> � 2��^ - PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � - '�` WORK WILL BE COMPLIED WITFI WHETHER SPECIFIED HEfiEIN OR <br /> �ec scai IONOFPqOPERTY� NOWNBELOWpRATTACNIWOCOPIES) NOT. 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 /> OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> c J PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br /> VMCEI TN!I.D.NUMBF,R CONTRACTORS LAW 18.27 CJW/�ND 296.200 WAC. <br /> CONSTRUCTIONIOANLENUER.�ODRE55.TELEPHONENUMBER 1 '� � <br /> x � iU-i�c--SI— <br /> __ SIGNATU E DATE <br /> CITV BUSINE55 UCENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. Ti rE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—/VHNDLGUNITS—H.P. � <br /> BATHTUB ; I FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK E DISP � / CLOTHES DRVERS ' <br /> DISHWASHER � VENT�LATION FAN � <br /> LAUNOPY TRAY , RANGE HOOD � <br /> CLOTHES WASHER � / WATER HEATER , <br /> _ URINAL ' WOOD STOVE � <br /> ORINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) ; <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PPEVENTERS ; GAS FIREPLACE ' <br /> � <br /> SINK(SERVICE—�AR, ETC.) / GAS RANGE � <br /> ' GAS PIPING � <br /> i EXHAUST FAN ' <br /> � , <br /> SUB TCTAL 3 ' SUB TOTAL $ ; <br /> PERMIT 5 i PERMIT 5 ,j � <br /> TOTALFEE S � TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> /PONT SFTPACK RERR SF.T6ALN SIDE SETBnCK PL�N CIIECK NUMOFR f[F RFCEIPT NO. <br /> UGE 201.' LOTRREA vncnNt srt[ FEES VALUATION FEE <br /> f1YE$ fl NO <br /> — 11WlOMG j <br /> i <br /> H[IGNTLIMITFTION NOOFpWGILING SIZEOfpLOG4� <br /> UN115 PIUMPING � <br /> UCCUP�NCY NO Ot510mE5 OGCUP�NTIOA� BASEMENi I <br /> GROUP MGGHnNICnI i <br /> IIYES ti NO � �-- <br /> 41IDI I ION�L PI�N CNf CK � <br /> FIRE�URM REOD fif�50N i <br /> __�—_ <br /> O1HER � <br /> FlRF SPqINKLER RF.OD FE�SON <br /> SiN C OUII�W G$URCN�qGE � <br /> irre ur r.or+si rinNs aornoveo nv CITY OF EVERETT runnr,won�s <br /> LOCAL SALES --%-- <br /> �q,t TAX CODE�S 3105 T07A� <br />