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APPLICATII..� FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOLITION fl COMBINATION �y BUILDING �7 MECHANICAL f� PLUMBING I-I SIGN <br /> PROJECT ADDRESS ��i7�LD / /J S� <br /> � /7J� <br /> owr+En Mmipoonr:ss arv rm r��orvE <br /> Jvt. l7UVty aoyv9 `v �'ic�n�v�n���'C( ✓��l+e�/ 9frriz/ `/YS-a39Y <br /> TENRNT MAII.ADDRFSS CITY ZIP PHONF <br /> PRCIIITCCT OR UESIGNEfi MAILAO�R[SS G1Y ]IP PHONE <br /> GENEMICONtRAG10R MAILApDR@SS CItY IiP PIION[ STATEUCENSE� <br /> pul�� '��o �nts 2�5� 7 � �°�Ark.��lk�f r�,1h��r 9Q�� � S'ts��s9y vuvei�� ��a9 <br /> ldECNANICALCONiq�CTOR MMLADORE55 CIiV ZIP PIIONE STATEUCENSE• <br /> PWMBINGGONTRRCTOR M41�p00RE55 CIiY ZIP PHONE STAIEUGENSE� <br /> CONTRACT PRICE OF WORK <br /> HEATI�'G SYSTEM: ❑GAS �Q ELECTRIC fl <br /> DESCRIBE WORN ANU SOUnPE FOOTAG[INVOLVEO COYTACI PERSON�ND PIIONE NO. <br /> IVtG� Rf r2c� � o <br /> I HEREBV CERTIFY THAT I HAVE REAO AN� EXAMINED THIS <br /> PROPOSEOlISE OF OUILOING APPLICATION AND KNOW 7HE SAME TO BE TRUE AND CORRECT.ALL <br /> �l PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> S F I WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGRLDESCRIPTIONOFPROPEPtt�SHOWNBELOWORAiTACNTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or 2� o�ocK�oF �n�'�t�F� /�JsO�i,r Ciu I AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> j / OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br /> 1'- �Z. ,��� -�-�� 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 � COMPLY WITH THE STATE <br /> PARCElTA7f I.D.NUM�ER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONQRUCTIONLOANLENOER.FOPRESS.IELEPHON[NUMOER x /����Lj J <br /> SIGNPNRE �ATE <br /> Cltt BUSME55 LICENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> Z WATERCLOSET�TOILET) � A/C—AMNDLGUNITS—H.P. � <br /> ',Z BATHTUB ; �C�C� FORCED AIR SYSTEMS—B.LU. M E.A. ' <br /> --� <br /> LAVATORY(WASH BASIN) HEAT PUMP � <br /> SHOWER � UNII HEATERS—D.T.U. M <br /> KITCHEN SINK R DISP � ( CLOTHES DRYERS <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRYTRAY RANGEHOOD i <br /> CLOTHES WASHER � WATERHEATER � <br /> URINAL WOOD STOVE ; <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) ' O i DO <br /> FLOOR DRAIN � FIREPLACE INSERi (WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GASFIREPLACE � <br /> SINK(SERVICE—BAR.ETC.) GAS RANGE � <br /> � GAS PIPING ' <br /> EXHAUSTFAN � <br /> � �UO <br /> i <br /> SUBTOTAL 3 � SU�TOTAL 5 � i J <br /> PERMIT S i PERMIT 5 � <br /> TOTALFEE 5 � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> fRONTSFIDALK R[4RSf:T3ACK SIpESETOACN PIANCNBCNNUMO[R �EE �ECHPTNO <br /> 2 0 ' 2 0' S� 1,��/n� .307•�!S /095'�l0 <br /> usezor+e IOTAR[A �AC4Ni5liF. FEES VALUATION FEE <br /> —I LG� P�ES fl NO pIIILDING � � • i Q(� <br /> HEIGHT�IMIIFTION NOOFUWELLING SIZ(_OF�LIXu� /_ � <br /> 2 u�virs Il� 5� C�1RACGE r�un�oiruc CL'�j' ���� <br /> OCCUPRNCY NO OiStOPIES UCCUPANILOAU BASEMENt MECH4NICAL �_i(J(� <br /> cnou <br /> ' _� � nrrs N�o � � <br /> FlREALARMREOD RE450N ApDITIONA�PLANGHECN i <br /> NO on�eH ���,�.. I) i i7i� <br /> FIRE SPRINKLER REO'D PEASON <br /> .^ STATEOWL�INGSURCIIARGE f � � ,? <br /> V <br /> T`.PF OP CON57. PLANS APPI`OV1�o ev�� CITY OF EVERETT �UOLIC WORKS �'f CJ ;c�. "' <br /> �1 t'� LOCAL SALES <br /> �-IJ oni� �Z(IS TAX CODE IS 3105 TOTAL � �;? � �1 <br />