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APPLICATIOr�i FOR CONSTRUC7 .JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STFlEET•EVERETT, WA 98201 �259-8810 � <br /> �I DEMOLITION i 1 COMBINATION rl BUILDING � MECHANICAL f1 PLUMBING fl SIGN <br /> PROJECT ADDRESS <br /> OWNEP MAILAD�RE55 CIiY Zm PNONE <br /> ai.,c.tiAm f(�rDn/ /oaoi -�sr /�a SE Evtxt-rr 98�0�' �h/7-S�o 'J <br /> TENANT MRILRODRE55 CIiY ZIP FNONE <br /> ARLNITCCTCR�ESrNER MAILADD�E55 CIfY 21P PNDKE <br /> GENEPRLCONTPRC70R M/.�LPUD(i[SS C�TV lIP PHONE SiATE�IGENSE� <br /> MECHRNICAL CONiRACTOR MPII ADDRE55 Lltt ZIP PHONE STRTE IICENSE� <br /> '1`E// <br /> PLUMBINGCONiRr1CTOR MAILADDRE55 Cltt ZIP PNONE STATEUCENSEr <br /> CON1RnCT PRICE OF WORK <br /> HEATING SYSTEM: f� GAS �CELECTRIC 11 <br /> DESCRIpE WORK�ND SOUARE FOOTPGE INVOIVED �ONTACi PERSON R PMONE N0. <br /> UGE7C <br /> E7aY - i r <br /> I HEREBY CEP.TIFY THAT I HAVE READ AND E%AMINED THIS <br /> _.— APPLICATION AND KNOW TH[ SAME TO BE TRUE AND CORRECT.ALL <br /> vaoPoseo u5e oF eunort+c� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WOFlK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�LOESCRIPTIONOFPAOPERtt(SHONTlBELOWORATTACN7WOGOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTIiER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEH OF THIS PROPERTY TO PERFORM THE WORN FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> f ARGEI TRIf I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> (09 - o - �/ - 00 � p <br /> CONSTRUCTION LOAN IENpER.RpDRE55.TELEPIIONE NUMBEA X � OY� / � <br /> SIG Ufi[ ORTE <br /> OX 7i3-/ <br /> CITY BUSINESS LIGENSE N0. <br /> PLUMBIN6 MECHANICAL <br /> NQ. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF FIXTURE OR ITEM FEE <br /> WATERCLOSET�TOILET) � PJC—A/HNDLGUNITS—FI.P. � <br /> BATHTUB ; FOPCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRY[RS <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAV � RANGE HOOD i <br /> CLOTHES WASHER i WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> ORINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) <br /> FLOOR DRAIN � FIREPLACE INSERT(VJOOD BURNMG) � <br /> BACKFLOW PREVENTERS ; GA: FIREPLACE <br /> SINK(SERVICE—BAR,ETC.) � GF.S RANGE ' <br /> GAS PIPING ' <br /> i EXHAUSTFAN �_ <br /> i � <br /> i ; <br /> i <br /> � � <br /> SUB TOTAL 5 ' SUB TOTAL S � � <br /> PEPMIT 5 � PERMIT S � <br /> TOTAL FEE S ' TOTAL FEE $ � '' <br /> FOR OFFICE USE ONLY: <br /> FPONT SETOACK REAR SETOACN SI�E$ETOACK PLAN CNBCN 1lUM�GR FG[ RECEIPT N0. <br /> usezoNe ioinnen vncnNtsite FEES VALUATION FEE <br /> nres �� �+o pUIL01NG � <br /> � <br /> HEIGMT LIMI7ATION NO OF OWRUNG 512E OF BLUGrtJ <br /> UNIiS 1+"JMOING � <br /> OCCl1P4NCY NOO�SiORIE> OCCUPANTLOAO BRSEMENI i <br /> GROUP NEGHANICAL � <br /> f]YES Il NO � <br /> RDDITIONRL PLAN CMECN i <br /> FIRE�LARMPEO'D R[ASON _T <br /> Oi11ER � <br /> � <br /> FIRESPRINNLERRE00 REASON � <br /> STAIE�IIIIDL�G SURCNAqGE � <br /> T�PEOFCONST PlANSAPPPOVEOBY CITVOFEVERETT �'UAUCWORKS � <br /> LOCALSALES � <br /> oqTE TAX CODE IS 3105 TO7AL I <br />