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APPLJCATIOrI FOR CONSTRUCT�ON fPERMIT��/ }�. <br /> CITY OF EVERETT•BUILDING DIVISION �/� <br /> 3200 CEDAR STREET• EVERETT,WA 58201 •259•8810 �N��"' <br /> I-1 DEMOLITION f l COM9INATION f� BUILDING f� MECHANICAL i 1 PLUMBING I 1 SIGN <br /> PROJECT ADDRESS <br /> ?S�� /CTl�.E' /�l n <br /> OYMER M�IIADDRE55 Cltt 2iP PHONE <br /> � �vST/C'G' S-d/r�cr Z��-/�3.� <br /> 1ENANT MAl1.�DORF55 Gtt lIP 1`NONE <br /> �PG111Tf.CT OR DESIGN[R MNI A�ORE55 Citt IiP �HONF. <br /> GENEMLCONiPaLtOR MRiIpD[1RE55 CItV I�P PHONC S1A7EIICENSE� <br /> MECHnNICAL CONTRnCTOR N�ILAD�RE55 GiV ZiP � PI�ONE SinTf LICENSE� <br /> ��%IG�/��Ti�rl� /9�7 G��5�0.�.�i��7! 7`r.��r�_�-�L��-��G�r- <br /> PW BINGCONiRAf, OR AIARRWRE55 QfY ZIP PHONE STAtELICENS[--r <br /> CONIR�Ci PRICE OF WORN � <br /> 21��- -�s'�, HEATING SYSTEM: }QGAS f1 ELECTRIC f l <br /> DESCRiBE WORK RNO SOUnRE FOOTnGE INVOLVED CONT�LT PERSON�ND PIIONE NO <br /> � <br /> C =— S hc_c� <br /> I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> //J� ,oSiY��L� APPUCATION AND KNOW THE SAME TO BE TRUE AND CORREGT.ALL <br /> PROPOSEDUSE OF BUILDING pROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br /> IEG�LUESCRIPTIDNOFPROPERTY15N0VMBELOWORATTACNTNUCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT e�ocK oc AUTHORITY TO VIOLATE OR CANCEL THE PROVISIQN OF ANY <br /> OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR TNE <br /> PC-RFORMANCE OF CONSTRUCT�ON.THAT I AM AUTHOFIZED�V THE <br /> OWNER OF THIS PROPEHTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> Pl1RCEL TIJ!I D.NIIMBER --<�/�/ <br /> CANSTRUCTiOHIO�NLENpER.ADDRE55.TEL6'��ONENUAIBER /��-�/� �/Fc�/ �/��'�— <br /> S�GN�TURE � E <br /> CITY BUSINE55 LICENSC N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlICTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATERCLOSET(TOILET) � FJC—AIHNDLGUNITS—H.P. � <br /> BATHTUB ; / FORCED AIR SYSTEMS—B.T.U. M E.A. i <br /> LAVATORV(WASH BASIN) i HEAT PUMP <br /> SHOWER � UNITHEATERS—B.T.U. M <br /> KITCHEN SINK 6 DISP CLOTHES DRVERS � <br /> DISHWASHER � VENTILATION' `N ' <br /> LAUNDRYTRAY � RANGEHOOD <br /> CLOTHES WASHER i WATER HEATER <br /> URINAL WOOU STOVE i— <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRA�N � FIREPLACE INSERT(WOOD BURNiNC�; ' <br /> BACKFLOW PREVENTERS � GASFIREPLACE � <br /> SINK(SERVICE—BAR,EiC.) GAS RANCaE <br /> GAS PIPING <br /> EXHAUSTFAN <br /> i <br /> � <br /> SUB TOTAL S ' SUB TOTAI $ O� <br /> PERMIT 5 PERMIT 5 / <br /> TOTALFEE $ TOTALFEE 5 ' � <br /> FOR OFFI�E S1SE ONLY: <br /> necemt r+o <br /> fRONT5FT0ACN PERf15fT(�PLN 5�[1ESEt[iACN �IANCdELN �0[P / �EF <br /> �V <br /> FEES VALUATION FEC <br /> USE20NP IUiAREA Vl�C4Ni51iF i <br /> IiVES I1 NO OUIl01N6 � <br /> � <br /> MEIGIITL�MItAT10N NN11WDWClUNG 512EO�9�D(+rtl i <br /> PLI1MOiNG ___�_ <br /> _ ' <br /> OCGUPRNCY NO Oi510R�E5 OCCUPFNTLOeD BRSEMENi MEGInNICPI � <br /> GRUUP —— ' <br /> ItYES I1 NO � <br /> PDUIIION�L PLAN CH[CK ' <br /> FIREALMMfiEO� fiFRSOY -----�— <br /> O1NEP _ <br /> fIRFSPRINKIFRRFO'0 �FAFON <br /> SiAt[OUtLDINC SIIRCN4RGE _ <br /> rrreorrousr r�nH�;nrrnOCEOPr CITYOFEVERETT runiir.wonKs _ <br /> LOCALSALES <br /> ��p�E TAX CODE IS 3105 70TAL <br />