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APPLICATI�.�1 FO� COPISTRUC7 .�N PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> rl DEMOLITION r 1 COMBINATION f� BUILDING �1 MECHANICAL f l PLUMBING I� SIGN <br /> PROJECTAnDRESS / la I T/ ��-j� � <br /> � /�����.cJ � <br /> ���n MnaaoonEss cm 1ir <br /> r��oNc <br /> /..�.2FA� /lZ�N �uZCI ��..�o�a (.4�a �,���«.� �71J(n � 7�7-67ou <br /> iENANT IAl ..Appqf$5 fITY ]IP PIIONE <br /> ARCNITCCTORDESIGNEF MAhAD�RE55 p7Y IIP PIIONE <br /> GEN[BAL1CONTAACTOR MAILADDRESS PHONE <br /> ��L�L//�C4 /�/�f/C/4'Ca1�h'L��/Z ��S� L�ns�� �y( C�y �.1�{(�+� ll� SiATELICENSE• <br /> r y �2�� ) 7E�7-6>00 <br /> IdCCHANICRLCONiRACTOiZ/' 1.1AILADDP�SS C V 21P PNONE ' STRTELICENSE� <br /> � Cc� ! ��[rY4�n�i4cr� 25ZU l,_.�l..l,�,'!y Gy�r��.+.�1.0 /zo�� 797 G7oo <br /> PWMBINGCONTRACTOR MnILADDPE55 tY ZIP PHO <br /> STATE UCENSE� <br /> CONTRPCT PqICE OF WORK <br /> HEATING SYSTEM: ❑ GAS f� ELECTRIC ❑ <br /> OESCRIOEWORKFNp�O^AR FOOi�GF�N�OLVED CONTACiPER50NANOPHONENO <br /> � �ti,c;. .�s�s�, �2��J) 337—y�33 <br /> I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> vaoros`ouse o�uaoiNc�'(// APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> PROVISIONS OF LHWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ��' WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCFIPT oFPnoventtisr�owKw OWORATiqCNTWOCOPIE51 NOT. THE GRANTING OF q pERMiT DOES NOT PRESUME TO GIVE <br /> �°T e�ceK— oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUC?ION OR THE <br /> PEAFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> rnace�Tax i.o.NurnsEa CONTRACT LAW 1827 RCW AND 296200 WAC. <br /> i{ <br /> CONSiPUGiION IOaN IENDER.PDDRESS.TR[PNGNE NUMBER X / 'A ��_ /��� _G� <br /> / /u � <br /> S�MMSGI( 04TF <br /> CITY OVSIN S.LICENSE NO. <br /> ` PLUMBING MECHANICAL <br /> ♦ � NO. TYPE OF FIXTURE OR�TEM FEE N0. TYPE OF FI%TURE OR IiEM FEE <br /> � WATERCLOSET(TOILET) � A/C—AMNDLGUNITS—H.P. � <br /> i <br /> BATHTUB � FORCED AIR SYSTEMS—BS.U. M E.A. � <br /> LAVATORY(WASH BASIN) i HEAT PUMP � <br /> SHOWE� � UNITHEATERS—B,T.U. M i <br /> KITCHEN SINK 8 DISP i CLOTHES DRVERS � <br /> OISHWASHER � VENTILATION FAN � <br /> LAUNDqY TRAY ' RANG[HOOD � <br /> CLOTHES WASHER WATER HEATER � <br /> URINAL — WOOD STOVE � <br /> DRINKING FOUNTAIN -� METAL FIREPLACE(WOOD BURNINCa) i <br /> FLOOR DRAIN � —� FIREPLACE INSERT(WOOD BURNING) r <br /> BACKFLOW PREVENTERS � GASFIREPLACE � <br /> SINK(SERVICE—�AR,ETC.) � GAS RANGE � <br /> � — GAS PIPING <br /> i (7 EXHAUST FAN <br /> i � <br /> i � <br /> _�_ <br /> � <br /> SU�TOTAL 5 � SI�B TOTAL $ � <br /> PERMIT S i PERMIT $ � <br /> TOTALFEE $ � TOTALFEE $ � <br /> FOR OFFICF ii�E Ot�LY: <br /> FRONTSETBACR R[MSETOACK SIpESETBACN PL�NCHECKNU R F[E REC[IPTNO. <br /> � r �� <br /> usezoue iornnen vncnrvrsite FEES VALUATION FEE <br /> Il YE5 fl NO pUIL01NG � <br /> HEIGHT LIMITATION NO.OF OW[LLING SIZE Oi�LDGrtI <br /> i <br /> UNITS <br /> PWMpING � <br /> GROUPpNCY NO O�Si0RIE5 OCCUPANTLOAp BASEMENT MECH�NICAL � <br /> i <br /> ❑YES fl NO <br /> i <br /> FIFE FLARM REO'D q[ASON PD�iTIONFL PLAN CHECK � <br /> i <br /> i <br /> OTN[R � <br /> FIRE SPRINKI.ER PEO'0 REASON i <br /> STAI[O�ILDING SURLHAqGE � <br /> I <br /> rrrEOFcoNsr P�ANSAPPROVED�Y CITYOFEVERETT ��uoucwonKs ' <br /> LOCALSALES ' <br /> onre TAX CODE IS 3105 TOTAL I <br />