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�, <br /> APPLICATIOrI FOR CONSTRUCT�dN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> f-1 DEMOUTION fl COMBINATION fl BUILDING f-I MECHANICAL i"��UMBING fl SIGN <br /> PROJECT ADDRESS � <br /> ') /t � �/� > �— ,�/' <br /> OYMER MRILADDRESS CITti 21P PI/ONE <br /> i , 9-�sU/`i�>57- �(3� <br /> LLrY�t.(�t�•:c d �L�4�,, ��cti / >/• �,�- l�(' '�i=-Fllc.f'• ��;"�F7T 7J <br /> TENRNT Mr11LR0Up[55 �ITY 21P PNONE / <br /> ARCMITfCTORDE5IGNEN MRII.ADDRE55 CITV lIP PNONF <br /> GENER�LCONTMCIOR MnILADI)RESS CIIY ZIP PIIO4G c�qiG11CGN5E� <br /> MELHANICALCONIR�CTOR MRILADDRE55 Cltt 71P p110NE STATEUCENSE� <br /> PLU GCON7RAGiOR MAILAD�RE55 �ITV 21P PIIONE STATEUCENSE• <br /> CONiR�CT PRICE OF W R � C� � <br /> �/ 7 Q HEATING SYSTEM: I i GAS Gi ELECTRIC f-1 <br /> DESCRIBE WOPK PND SpJARB FOOT�GE INVOLVE� CONIDCT PERSON RND PIIONF.NO <br /> il�G� ;�LIif4�' _ `, �J , ,/ <br /> i � <br /> _�t'.,�,��r�u, q" 'i�� I HEREBY CERTIrV THAT I HAVE READ /1ND EXAMINED THIS <br /> � `��" ' APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> raoPo5eo use oF aua �:, � PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHEF SPECIF�ED HEREIN OR <br /> LEG�LDESCRIPTI(MOFPROPERTY($HOWNBELOWORATfACNTWOCOPIES� NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocrc or 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 AND I COMPLY WITH THE STATE <br /> P�RCEL TAx I D.NUMBER CONTfiACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSiRUCTION LOAN LENUER.FU�RESS.TELEPHONE NUMBER X{�}:C�I�'����!�C"/y'���� �� I� �/ ^ <br /> SIGNATUPE ORTE <br /> CITY BUSINE55 LICENS[NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNRS—H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> i , <br /> / LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> I KITCHEN SINK&DISP ; CLOTHES DRYERS ; <br /> OISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ' RANGE HOOD � <br /> � <br /> CLOTHES WASHER � WATER HEATER —� <br /> URINAL � WOOD STOVE � <br /> � <br /> DRINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERV�CE—BAR, ETCJ GAS RANGE � <br /> ' GAS PIPING � <br /> � EXHAUSTFAN ; <br /> � , <br /> � ' <br /> � <br /> �— <br /> SUBTOTAL $ -'� SUBTOTAL $ ' <br /> � <br /> PERMIT 5 2U � PERMIT 5 � <br /> TOTAL FEE $ 'r� TOTAL FEE $ � <br /> FOR OFFICE USE ONIY: <br /> FRONT SFTPRCN REAq SFTAACK SI�E S[TBACN Pt nN C11ECN NUMOf.f1 ('EE �ECEIPi N0. <br /> usezoNe iornnen vncanisire FEES VALUATION FEE <br /> rires i'� r+o ounnwr <br /> HEIGNT IIMITAiION NO OF UWRUNG SIIE OF BLDG41 � <br /> IINIiC <br /> P�IINf11NC <br /> OC�.UPANCY NO Of SIORICS OCCUPpNT LORO (fASEMENT i <br /> f.fiOUP M[CIIANILAL i <br /> IIVES I1 NO — — <br /> FIRE�URMREOD (iFA50Y ADDI110N�I.PL�Nf.��f.CK <br /> i <br /> O111ER i <br /> 1 <br /> Fine snniNKien aeon acn�on <br /> — �-- <br /> srme ounoimr,sunpmnr,c ; <br /> TYPEOFf,ONST PI�NSAPPROVF.DpY CITYOFEVERETT runiicwonHs i � � <br /> LOCAL SALES '- - -- — <br /> uAiF TAX CODE IS 3105 707AL <br />