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APPLICATIt,N FOR CONSTRUC110N PERMIT'� <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> f-1 DEMOUTION f 1 COMBINATION 1�Q� BUILDINCa I 1 MECHANICAL i ' PLUMBING f 1 SIGN <br /> PROJECT ADDRFSS „ <br /> ��! v J� .�/(SR, . f�1l.-U. ��/EM1-E.'T� 2 — c_I tp� 7/ <br /> OWNEB MnILRDDPE55 CITV Zi�' PMONE <br /> IENANT MAILApORE55 CITV IIP PHONE <br /> ����N�. <br /> ARCIUTF.CTOR�ESIGNER h1RIlAD�NE55 GIiY I�P PHONE <br /> �� � � ' CIiY ZIP P�IONL Sfpi[ULENSE� <br /> G[N[OALCONiOACtOB MAILRU�RE55 <br /> ^ 2��r F!-IJ <br /> MECHANICALCONTfi CTOP MnILA0�RE55 LITY ZIP C110NE STATEUCF.NSE� <br /> PLUMBINGCONIRP,ROR MAIL�ODRE55 GIN 21P PNO�IE STATELICENSE� <br /> corurnacrPwcEOFwonK / 06� HEATING SYSTEM: f 1 GAS �l ELECTRIC �i <br /> 4� <br /> OESGP'OE WORK RND SOU�AE FOOIDG:INVOLVEO CONTACT PEPSON ANO PHONf:NO ��6 M1�<--y �7 <br /> � aJ <br /> Con/57�-�`'T C�/�/Sn.��R'N� 5 C�rt�}�u.� T�n�l3o/z.5,e-I <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> rnoroseo use oc euaort+c PROVISIONS OF LAWS AND ORDINANCES GO'�ERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGPlDESGfiIPTIONOFPROPERiY�SHOWNOE�OWOPATfACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> iaT eiaK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION JF ANY <br /> OTHER STATE OR LOCAL LAV!REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PEFFORM THE WOFK FOR WHIGH <br /> APPLICATION IS MADE AND I COMPLY WITfi THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> PFPCELTA%ID.NUMBER <br /> X �-ar� / ���.��' i i��' <br /> CONSTRUGTION LO/•N IENUER RDORE55.TELEPNONE NUMBER DATE <br /> SIGNR E <br /> CITY 9USME55 LIG[NSL NO. <br /> PLUMBING MECHANICAL _ _ <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. <br /> BATH?UB ' FORCEDAIRSYSTEMS—B.T.U. M E.A. ; <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 /> LP.UNDRY TRAY � RANGE HOOD <br /> CLOTHES WASHER i WATER HEATER ' <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIREPIACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR, ETC.) GAS RANGE <br /> � GAS PIPING <br /> EXHAUSTFAN ' <br /> i <br /> i <br /> � <br /> Sl�3TOTAL 5 � SUBTOTAL $ i <br /> PERMIT S i _ PERMIT S <br /> TOTAL FEE S ' TOTAL FEE 5 <br /> FOR ()FFICE USE ONLY: <br /> P{iONT'iFTPACK RE�RSFTORCN SIDESET�ACK <br /> PLANCIIECNNUMBfti f[f RECe1PTN0. <br /> FEES VALUATION FEE _�. <br /> USE ZONF. l01 AR[A VACRNT SITE — / — <br /> IlYES ��� ���� pUIIOWG (�� 000 _ <br /> IIEIGNT UAIItPT10N NO OF UWELLING SiZE OF BLDGRI y— <br /> pv PLUNpING <br /> ✓ —� <br /> OGCUPAWCY NO 0�510�1[S OGCU1'ANTl04D 9�SEMENi MECMnNICRL � __ <br /> cnoi� � 3 / 1 nves l'�'^� - -- <br /> ADDIIiONI.L PLAN P�f.CF L� <br /> (iRE4L4RMREO�D RfA504 -- <br /> NO OIHEN — _ <br /> �IHfPfRI�KIERiiEOO A[�SON qtp��ppILDINfiSURCdMGE ;� <br /> 0 <br /> :rre or coNsr ri.nNs� r7�oveo or CITY OF EVERETT runnr,wonKs _ _ ___ <br /> �M� LOCAL SALES ; <br /> � / _ /� i�ntEl�' _��� TAX CODE IS 3105 TOTAL � __ _�— <br />