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APPLICATII .� FOR CONSTRUC7 .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> f l DEMOUTION I I COMBINATION I i BUILDING ;Z MECHANICAL (l PLUMBING f 1 SIGN <br /> PROJECT ADDRESS / <br /> � E U '(� <br /> owNen rnni�nooness em r�r ri�oNe <br /> K� /�« k� � � � , � ��, �, f� _�o �� - o� �/ <br /> iENANT MAILPOORF55 f,ILY ]IP PNONF <br /> ARCNrt[CTOR�ESIGNER MqILqDORESS CITY 71P PH04E <br /> GENEf1AlCONiPACiOR MAII.AODRE55 CI1V 7.iP PIIO!�E SiATEIICENSE� <br /> (`H�MECNnNIC�LCONTq4CiOR hy ILA�DRESS �ITV 71P FIICkF. STOTELICENSE� <br /> �o ?. 0 l�C�i �ri�t{ � v ?,?/•17 ,�.�/���. �i'� '1.��,^ i 93,T- Y!`UY��o��/Ezi�.n�.r <br /> PLUMBINGCOt1 iACTOP NN�A E5S qiV ZIP PIIONE $TAiEUC[NSE� <br /> CONTRACT PRICE OF WOPN <br /> ,� ? r� U HEATING SYSTEM: ;7aGAS ❑ ELECTRIC fl <br /> DESCPIOE WOfiK AND SOU�RE FOOT�GE INVOW[D CO4T�Ci f ERSOY AND['HONE N0. <br /> I HEREBY CERi1FV THAT I HAVE REF.D AND EXAMINED THIS <br /> PROPOSED USE�ou DING APPLICATION A��D KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �Ecn�oescairnoNOFPnoveatttsHowNee�owonnnnc��nvocoaies NOT. iHE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or o�ocK oF AUTHORITY 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 AUTHORI2E0 BY THE <br /> Ol"lNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE SI�ATE <br /> vnnce�tax i o.Nu�,�eEa CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSiRUCPONIOqNLEND[R.AD�RESS.TELEPHONENUMO[R X �/L<!Z�L�� /LtiL.I-�-��"�/ �"��—I � <br /> _ SIGNaiURE pAT[ <br /> CITV BUSINE55 LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FI%TURE OR ITEM FEE <br /> WATERCLOSET�TOILET) � A/C—AMNDLGUNITS—H.P. � <br /> BATHTUB � FORCEDAIRSYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER UNITHEATERS—B.T.U. M <br /> KITCHEN SINK 8 DISP CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> IAUNDRY TRAY RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER —r <br /> URINAL � WOOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNIIJG) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS � GASFIREPLpCE � <br /> _ SINK(SERV�CE—BAR,ETQ) GAS RANGE <br /> ' GAS PIPING � <br /> i E%HAUSTFAN i <br /> i � <br /> i <br /> i <br /> SUB TOTAL 5 � SUB TOTAL 5 � �� <br /> PERMIT S i PERMIT $ /L� � ��jQ <br /> TOTALFEE S � TOTALFEE 5 � <br /> FOR OFFICE USE ONLY: <br /> fqONTSETpACK R[MSETEIACN S�DESETOACK PLAN I ,LKNU\�F�� FEE REC[IPTNO <br /> (� <br /> usezoNe turnnen vncnNisrtE FEES VALUATION FEE <br /> nves n no owioiNc I <br /> � <br /> i;[IRMT LIMITRTION NO.JF OW[LLING SIZE 0��I DGITI. <br /> I UNIiS P W NItING i <br /> OCGIIPAVCV NOO�SiO�il[5 OCCUPpNiLOAp OASLMGNi � <br /> (iROIIP M[CIIANICAL � <br /> f1YG5 Il NO � <br /> I <br /> FIREALAqMR[OU B[ASON A�OITION�LPLANCHECK i <br /> OTN[R i <br /> FIRE SPBINNLER R[0'D REASDN <br /> i <br /> SiATE OW101N0 SURCHARGE i <br /> i <br /> rvaeoFcoNsr v�nnsarrnoveoer CITYOFEVERETT vunur,wonKs � <br /> LOCALSALES ; <br /> i,��� TAX CODE IS 3105 TOTAL ; <br />