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APPLICATIL.� FOR CANSTRUC7 .ON PERMIT <br /> CiTY OF EVERETT•BUILDING DIVISION ���s�1T <br /> 3200 CEDAR STREET• EVERETT,WA 9A201 •259•8810 <br /> f7 DEMOLITION G'�COMBINATION f7 BUILDING ❑ MECHANICAL Il PLUMBING rl SIGN <br /> PROJECTADDRESSp,G��,l������' �E.. � ✓en,�- W� �)�:�o�}' <br /> ��(3 <br /> R1L�. ��C�ttjNJ�MpiL7Ql�cn�.PS4\{ L �(J�����1 7"�0���� rHONJ�� — ��So(� <br /> RNT MAILADURE55 [:ITV 21P 1'NONE <br /> PRCHITECTOROESIGNER MRILMORE55 Qtt ZIP PHONE <br /> GENERALCONRIACTOR MAIUODf1E55 CIiY 21P f�HON[ STRTELICENSE� <br /> MECMANICRLCONTRACTOP MAIIADDRE55 CITY 21P PHONE c�qTE1.ICENSE� <br /> PLUMBING CONTRACTOR MAILADDBESS CIN ZIP PN011E STr1TE LICENSE� <br /> CONTR�CTPRICEOf WOnN <br /> �S� 00 d ,, HEATING SYSTEM: ❑GAS �ELECTRIC ❑ <br /> UESCRIBE WORK AYD SOUARE OO7AGE INVOLVED � CONTACT PERSONANU P110NE N0. <br /> /-Ic-ICI �/ l� u r.l�� ovl'�c� ��;N r�' i � .�� - 01� <br /> �f�R 5(� �— <br /> Qa—t. I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> — APPLICATION AN�KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> vFo SEO USEOF Bl11LDING pRpVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPIIED WITH WHETHER SPECIF�ED HEREIN OR <br /> LEGr1LDE5CRIPTIONOFPPOPEHTY�SMOWNBELOWORATTACHTWOCOPIES� NOT. THE GRANTING OF A PERMIT DO-O M1OT PRESUME TO GIVE <br /> ior � e�ocK ov AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> �.O 7 �� C��..� ��' �vercft-,y Nort P<A� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> P Cc rd L J 4 ti ncr RPC i� 0 !�O -.O� 1 PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> �J3 e/�A �ev�ro�T�nct ��; (jevcr/y y,"o1d�'��77QAC�'s� OWNER OF THIS PROPERTY TO PERFOFiM THE WORK FOR WHICH <br /> jyl5ie�v N� I •- uva1.IJ �• � �,�Y<,c•�C�. Sn.�l �; APPLICATION IS MADE AND I COMPLY WITH THE S7ATE <br /> P�RCELTA%IA.NUMBER CONTi7ACTORS LAW 1827 RCW AND 296.200 WAC. <br /> ��� �� fl��� � <br /> C 5 FUCTI IO�N LENDEA.ADDf�E55.TELEPNONE NUMOER x �� ,��,�,,,�SL/�-a�l-9�- <br /> SIGNATURE ORTE <br /> CITY OUSME55 UCENSE N0. <br /> PLUMBINO MECHANICA'_ <br /> NO. TYPE OF FlKTUpE OR ITEM FEE NO. TYPE OF FI%TURE OR ITEM FEE <br /> S/ WATERCLOSET(TOILEn � A/C--A/HNDLGUNITS—H.P. � <br /> BATHTUB ' ; FOR�EDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � \ HEA'.�PUMP i <br /> OWER � � UNITHEATERS—B.T.U. M ' <br /> lJ KIT EN SINK 8 DISP � � i CL�THES DRYERS i <br /> DISH HER / � VENT TION FAN � <br /> �AUNDR RAY � RANGEH� D � <br /> CLOTHES W HER � WATER HEAT � <br /> URINAL � WOOD STOVE ' <br /> DRINKING FOU A � METAL FIREPLACE( D BURNING) i <br /> FLOOR OR � FIREPLACE INSERT WOdABURNING) � <br /> BAC!CFL PREVENTER ; GAS FIREPLACE ; <br /> SINK RViCE—BAR,ETC. GA3 RANGE <br /> � � GAS PIPIN ' <br /> � i EXHAUST AN i <br /> � � <br /> i � <br /> � � <br /> � � <br /> SUBTOTAL 5 � SUBTOTAL 5 ; <br /> PERMIT 5 i PERMIT $ � <br /> TOTALFEE $ � TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT$ETPACN REAR SETOBqCN SIpE SET09CK PLAN CH[C�UMBER, � FE� �C PE��N0. J � <br /> liQ�/ � <br /> � 7 . � �'j'— <br /> USE20NE '� LOTAREA VACr1Ni51TE � F ES VALUATION FEE <br /> fl YES NO BUILDING I z�h�a� ) �J� <br /> HEIGMTLIMITATION � NO.OFDW[LLING 512EOFBLDGT. i <br /> UYITS � � 7 PlVM01NG _� <br /> OCCUPFNCV NO OFSi0RiE5 OCCUPANTIOFD BASEMENT MECMPNICAI <br /> G OUP -- - <br /> � 2 � ❑YES � qDDIT10NALPUNCHECK '� i �� <br /> FIRE�URM PEO'0 REFSfO�N <br /> c f !".'�(1� . OIH[R � / � <br /> FIRE SPRINNLER PEO'� REASCN � � � � <br /> y� i{S��� STAIE OUILDING SURCMnRGE ����/� <br /> ( <br /> TVPEOFCONST. PlAN5A1`PROVEDOY CITY OF EVERETT �UBLIC\YORKS / n ' -- <br /> V ' I �tR .�� i�^ LOCAISALES <br /> onre ' -'� - I b-'i� TAl(CODE IS 3105 TOTAI �� I' <br />