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APPLICATION FOR COMSTRUCT�UN PERMIT� <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> fl DEMOLITION fl COMBINATION b� BUILDING I-1 MECHANICAL �l PLUMBING f 1 SIGN <br /> PROJECT ADDRESS S � 3� (� �rn � 1 � �� G <br /> W <br /> OWNER M/ILApDRE55 CITY ZiP PIIONF <br /> �icu�� �bs� 3r3 � `� �.w�ce �� c�F�c�r2� �caoi <br /> TMPNT M�ILADDR[SS CITV 21P FNONE <br /> 5qG�nG <br /> ARLHITCCT OR OESIGY.ER MMl AOORF.55 Cltt lIP �MONE <br /> GEN[tinICONTRnCiIXi MnILAD011E55 Cilv 2iP P�ION[ S�nT@IICENS[� <br /> A �2�o�J c��si• 44ia c�7�'`�h�e ti7cs wc�5�c. �P�a�o �,9- r397 e��^zor,�c�o�sBs�J <br /> MF.CIIRNICnLCONTRACTOR MRILpD�Pf.55 Gtt DP P110NE STATkUCENSE• <br /> PUIMBINGCONTRRCTOR MAIL�OORE55 Qtt 21P �NONE $TRiEUCENSE� <br /> CONTRPCi PRIC�OF WORN <br /> HEATING SYSTEM: I 1 GAS fl ELECTRIC � i <br /> UESCRIBE WORR RND SOUFRE FOOTIGE INVOLVED CONTACI�ERSON AYD PMONE NO. <br /> v�' �oct= o ea U.2�o oJ � �qc� a �< � �C�' - l 3 `t _ <br /> u� l Z N COu,C 2�'f'�: C2.t��c ti eu.�J 6�T <br /> I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> APPUCATION AND K�OW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROPOSED UpSE OF BUILDMG PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> / TC�✓ ( C�� � �� L' WORK WILL BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br /> IEG�LDESCRIPTIONOFPROPERtt�SHOWNBEIOWORRTTRCHTWOCO IES) NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GNE <br /> �oT � S � 7 e ocrc�_or STAa�� 4�v ' AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> L� S . A� YO QV_T PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOR2ED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCEL TIJ(I D.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200�. <br /> 5�3f - � of7 - 000� �-/ l� Cr <br /> CONSTRUGPON IOAN IENDER.�DDRE55.TEIEPHONE NUMAEII +�J � �GaAr—�—R � S�lTT J�7 <br /> SICN�TURE On1E <br /> Citt BUSMESS UCENSC NO <br /> PLUMBING MECHANICAI <br /> NO. TYPE OF flIfTURE OR ITEM FEE NO. 7YPE OF ECUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.i? <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) HEAT PUMP � <br /> SHOWER � UNITHEATEPS—B.T.U. M <br /> KITCHEN SINK 8 DISP CLOTHES DRVERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRY TRAY � RANCaE HOOD � <br /> CLOTHES WASHEii � WATER HEATER ' <br /> URINAL � WOOD STOVE <br /> ORINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD OURNING) <br /> BACKFLOW PREVENTERS � GASF�REPLACE � <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE <br /> GAS PIPINCa <br /> EXHAUSTFAN � <br /> i <br /> i ' <br /> SUBTOTAL £ SUBTOTAL 5 � <br /> PERMIT S PERMIT 5 � <br /> TOTAL FEE S ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> fRONTSFTPACK PEAfI5FT0ACN 51�ESEiPRCN �lANC11ECKN1IMOFR F[F R[f.FIPfNO <br /> uSEzoNe ioi�nen wcnHisite FEES VALUATION FEE <br /> IIYES I� NO � � � <br /> ounnir+c <br /> IIEIGIIT LIMIT�TION NO OF OWEIUNG SIIE OF BIDGRI � <br /> UNi15 ptUNfiMG <br /> _ ' <br /> _ ' <br /> OCCUPANCV NO Oi SIONiES CU�4N1 L A BASEMENf MECIInNiCAL <br /> cn0ur � - <br /> fl\ES II NO <br /> ADOI11pNPt PIAN CNF.GK � <br /> FIREPLAl1MRE00 50� —r-- <br /> • Oi11E11 <br /> nne svnwK� n ne .ov � � <br /> $iAiFl111110MGCU�CHMGE '.. )/ ) <br /> �_ <br /> rvre or c rinNsnrrnoven or CITY OF EVERETT runnr.won�c <br /> LOCAL SALES – --------- �� <br /> ��q�� TAX CODE IS 3105 TOTAL <br />