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APPLICATIC- 1 FOR COt�STRUCT�)N ►�EfRilA1T <br /> CITY OF EVERETT•BUILDING DIVISIUN <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION Gd'BUILDING ❑,�ECHANICAL p PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: �, - yJ D/) /T�lA4�;/�'1�)�(/!" ? c / <br /> �T'1���[JILJT .I-J�IC. �O iVJ/i-Z-` /+�U^�'�-��"1'��III'9LJ 27S PHONE �Sa�`� ? J��O�(O <br /> �'���p MNLAOORES CI <br /> TENQiT MNLA[%1RE55 f.I1Y I�P P��ONE <br /> t3/ ! l . �,-ia�� Sn�iA zsTHrk�a .�S J• sr'� «ur-. 991Z�P 7�)435-FsSz3 <br /> 11RLHITECTOqDESIGNER MAiI�DRE55� Gltt � 7i1` PNONE <br /> __L�c.1LiN�i�n/ST. .tr �D ��ix�`2f �/j��.K.%%T ��A 98275— (J��r73S3-7�7L� /3niin�cS'/e��t�; <br /> GENEfiAlCON1f1eGTOR MMLI�ORESS LIIv / liP Pi10NE SIATEIICENSE� <br /> �[�yCJ f�ErTin7/— lr�<.. I�Zt� .a�S�`') Di2 sC Snri „�R. 7Hz4t� ��p7ZYU-�lll-e �.�nNicflSZ'`t <br /> MECNANICA�CONTRACTOR MAII ADDRE55 CIIV ZII` PIIONE SfAfE LILENSE� <br /> DiS�ic�n��- i'Luf.,�ntib Co I325 i�.3�� �� Se - �izF^T �.a� 9h.'�f�. �J � 3sa 3 � e � sr? 'ti i '3 <br /> PLUYBIN6CONTR�CTOR M�ILAOOPESS CIfY f LP PHONE STATEUCENSE/ <br /> / z <br /> CONTRAGTPPoCEOFWORN NEATINGSYSTEM: C7'�AS ❑ ELECTRIC ❑ <br /> f�Dlo��/.��/ So4 � 6�4�2ri4E <br /> DESCRIBE WORK AND SOl1ARE FOOUGE N1VOlVEO CONTACT f'ERSON�ND PNONE NO <br /> S/n)L�F F.ami��i <br /> I HeREDY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ' APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROPOSEDUSEOFBUIIDINO PROVISIONS OF LAWS AND ORDINAN.:ES GOVERNING THIS TYPE OF <br /> Loi#f.� /2111vcrnnr��r._ WORK WILL BE COMPLIE� WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�lDESCNIPTIpJOfPROPEIiTV(SHOWNBEIOWORARALIITW0001'IES� NOT. THE GRANTING OF A PERMIT DOES NOT PflESUME TO GIVE <br /> wi etocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> —� I o�, � 55�--oc�-o - o PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITN THE STATE <br /> PARCEL`V(I.O.NUMBER CONTIiACTORS LAW 18.27 RCW AND 296200 N'AC. <br /> T!J .� .% � . �� ��.�/�,.�� q <br /> COpNS'T�RIX,TION IOAN LENDEN.AOORE55.TELEPHONE NUMBER x �-%/-:/��_�� � - I� �/G� <br /> _L{���/�X 6Lu�f F ` � '� SIGN�TURE D�TE <br /> _ � <br /> CITYBUSINESSLICENS[NO�^ - � (• � -i <br /> • PLUMBING MECHANICAI <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E��UIPMENT FEE <br /> WATER CLOSET(TOILEn � � A/C—AhiNDLG UN!iS ' <br /> BATHTUB ; FORCED AIR fiYSTF:MS i <br /> LAVATORY(WASH BASIN� / � HEAT PUMP � <br /> � SHOWER � UNITHEATERS ' <br /> � <br /> KITCHEN SINK 6 DISP � <br /> CLOTHES ORYERS . � <br /> DISHWASHER � RANGEHOOD ' <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ' <br /> URINAL � METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN ; FIREPIACE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVEN7ERS i GASRANGE i <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING ' <br /> EXHAUSTFAN � <br /> _ � <br /> � <br /> � ' <br /> � ' <br /> � ' <br /> � ' <br /> SUB TOTAL S ; SUB TOTAL S ; <br /> / PERMIT S � PERMIT S � <br /> TOTAL FEE f ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: -iYt '7�ZG�/1I_�� Gm �5� � <br /> FRONTSETPACN A[�ASETBALK SIDESETBACN. PI�NGIECNNUMOfII fE� OFCFIPTNO <br /> �Zp �'� _ -3 .5 <br /> usez ior�s¢n veceNT �e FEES VALUATION FEE <br /> - ❑YES ❑ r+o nunnwn y3 � Q <br /> NEIGHTUMIJAj�Oy HOOfDWELUNG 512EOFB��+R1 .�.yC`{&1 � <br /> ��� UNiI,G / a C � p111��01NC � <br /> b� /' �� <br /> OCCUPANCY NO M SIOWFS OCCUPANI IOAp B�SEMENi /A//� <br /> GOWP 61Ef,11ANlf.n1 ---_ ��_1 <br /> Z N� ❑YF$ NO <br /> �UDIIIONAL PUN CIIf.CN � <br /> FIR SPRINNLERREO'D �EASON � <br /> � <br /> /J� on2n � <br /> FIREAlA1iMRE0'D AE�C(yl '� <br /> v ,J STAIEOUItOW65VfiC11�fIGE --- � ) <br /> TYPEOFf.ON$T �LANS���' �AY CITYOFEVERETT �uniir.wnnKs _ �Q�_ <br /> v � , LOCAL SAI.ES - �� <br /> u,,,E �S TAX GODE IS 3105 7oTAL <br /> jd/Z . ZC� <br />