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• . <br /> APPLICAT11.�1 FOR CONSTRUC'� .ON PERMIT <br /> CITY OF EVERETT• BUILDING OIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> f 1 DEMOLITION �1 COMBINATION � BUILDING � , MECHANICAL PLUMBING I-1 SIG4 <br /> PROJECT ADDRES� �7 <br /> ��Z� ����'C� �� �L !�/`T;r,C�� <br /> ���� MAILADDRE55 Cltt ZiP � PIIONE <br /> LGrtn po�e�/JH PJ.RoK SL'J� LV,n�lulctii-( L�j03� �u'G� 77ty-OSSS <br /> TENANT IdAILACDR[55 QTV ZIP IONE - <br /> RRCNITCCTOR�ESIGNf:R MRIIAD�RE55 CITY IiP PN�4E <br /> 1/� �f5f/J.J !>. N ZYI�J-C CHI���N�� lf✓L ['�rvC� -�/�j'71J� �2e6) 15 t��/ZG° <br /> GENER LWNTRACTOR MAILADDRE55 CIN )m IpNF StATELIC[NSEx <br /> L(�c_�i�ca� �naqy �'n�i<< f/eS PQ I�+TSU36 �4NnlCt� 9"U3�( �ZcC � 17b'OSSS <br /> MECl/ANICAILCONTRACTOF J MAI�AD/ORES/S ^ qR 21P PIIO�tE STA7ELI�ENSE� <br /> C-��tTil tt � �nti44 � Tiuc7uR s (U . �OX�(+3�+ ��/�vl(✓c�� 9ffJJ�6 2L`G <br /> � ) 776-csTS' <br /> PW}-MBMCCONTRACT/-03 MFILAODRES$ �j CITYI IIP PHONE STATEUCENSEr <br /> C�fc !t(N � CnC✓ �. 4t�'7) �U��N .7�3� L �hv�CC•:.� ���C�.(i q. 7�'QSSS <br /> CONTRRCi PRICE OF WOR <br /> 2 O HEATING SYSTF.M: ❑GAS ELECTRlC r7 <br /> DESCRIBE WORK ANO SQURRE FOOTAGE INVOLVED CONLACi f�ERSON ANO�HONE NO �J �.�1� <br /> v � ,� lc�l �LiCn C 2 /��/�,. <br /> 337-H733 715- u>SS ���i -v3i9 <br /> I HERE�V CERTIFY ThAT I HAVE READ AND EXAMINED THIS <br /> rnoroseo USE or euaDn+G APPLICATION AND KNOW THE SAME TO BE TRUE AND COR�,-'ECT.ALL <br /> y-PLE� f}�,.�/�y �,(t��� � PROVISIONS OF LAWS ANp ORDINANCES GOVERNING THIS TYPE OF <br /> � �O WORK WILL OE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> iecnioEsc irnor+orrRorEattlsNowrvne�owon cr�rnocori � e� • N T THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> i�T�ALOCK o� � � (/� (,A�HORITV 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 TFIE WORK FOR WHICH <br /> APPLI - N IS MADE AND I COMPLY WITH THE STATE <br /> vnncetinx i o.Hun+oea CON TORS LAV 27 RCW A 296200 WAC. <br /> CONS1tiUCP N LOnN LEND6A,1 DURE55.TEIEPNONE NUMAER � � //� y—9Y <br /> �������� • /� SIG FtURE / <br /> DAiE <br /> CIN OVSINESS l ICENSE N0. <br /> � � PLUMBING MECHANICAL <br /> i NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF FIXTURE OR ITEM FEE <br /> ' � WATER CLOSET(TOILET) � NC-NHNDLG UNITS-H.P. <br /> BATHTUB � FORCED AIR SYSTEMS-B.T. M E.A. ' <br /> LAVATORV(N'ASH BASIN) i HEAT PUMP � <br /> SHOWER NIT HEATERS-O.T.U. <br /> CHEN SINK 8 DISP i CL HES DRYERS ' <br /> DIS ASHER VENTIL ION FA <br /> LAUN�R RAY ' RANGE HO � <br /> CLOTHES WA WATER H E � <br /> URINAL WOOD TOVE � <br /> DRINKIN OUNTAIN ME L FIREPLACE(WOO URNING) i <br /> FLOO RAIN � � p EFLACE INSERT(WOOD B NING) <br /> B FLOW PREVENTERS � GAS FIREPLACE � ' <br /> INK(SERVICE-BAR,ETC.) GAS RANGE <br /> GAS PIPING � <br /> i EXHAUSTFAN � <br /> i <br /> i <br /> i � <br /> SUBTOTAL 5 � �UBTOTAL 5 � <br /> PERMIT $ � pERM1T S <br /> TOTAL FEE $ � TOTALFEE $ <br /> FOR OFFICE USE ONLY: � ' <br /> { � <br /> /)P'�l7 .�,. i ����i,^,'� [�:� ' <br /> PRONTSET�CN RFAPSETP4CN SI�SET�BACK i�lqNG1ECK �1.1�� fE[ ��� �� qECEIPi/lO.� � <br /> Z r 1 7 /C <br /> , <br /> , <br /> o zs „ <br /> USEZor+e �ornnEn vncnr�tstrE FEES VALUATION FEE <br /> - /O 5 Z F+es n r+o euanwr, ('lC0 �� "� � �'� <br /> HEIGNTLIMITATION ' NOOFOWRUNG 9ZEOFpLOGRI I <br /> �/f) UNITS � � <br /> L,O � PLVM9iYG � <br /> GCCU^ANCY Np0�5W�IE5 OCCUPRNiIOAp 9ASENENi MECI.AIIICRL � <br /> I M � ) ❑VES NO —I <br /> Fl E�IARMREO� RE�SON ADDI710NRLPLANCMECK � <br /> Y�� a�N,a�c� o,�,E� ,���I�ill � D! - <br /> FIRE SPRINKLER REO'0 �EASON <br /> ��(i � � <br /> �w StATE�l1IL�ING SURC11pRGE % � � ; ,/� <br /> TVPE OFCONST PLANSAPPqOVED�Y � i <br /> CITY OF EVERETT rumir,wonks iJ!,� -. <br /> -r Ai' � JM LOCAL SALES ^ - <br /> ••W� „q,� �� �C TAX CODE IS 3105 TOi.��'_ � ; �' � � <br />