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APPLICATION FOR CONSTRUCTION PERMIT /��� <br /> CITY OF EVERETT• BUILOING DIVISION � <br /> 3200 CEDAR STREET• EVEHETT, WA 98201 •259•8810 <br /> f1 DEMOLITION �l COMBINATION fl BUILDING [X MECHANICAL �l PLUMBING f l SIGN <br /> PROJECT ADDRESS <br /> �- - <br /> �. C,` ' 1 <br /> ovmen Mnanooness cm nr r�iomc <br /> ��E�/�, �� �IL � I"� `��--Tc:Y'� �l- � � —�{�� �\SZ " 5S� <br /> �EN�NT MRII.ADDR[55 GTV ZIP PIIONE <br /> /�� i <br /> RRGIIIICG ORD'ESIGN� MAlIA00RE55 OiV ]iP 1'��ON� <br /> �� <br /> GEN[RMCONiPRCIOq MnILA��fiE55 f.I1V � iiP PIION[ StAIEIICCNSE� <br /> rJ� t�lAice�Ar,� �Sod 'I ,� ��� ����tX1�1`1 �.��-��� �l�rzT���P� �a �� <br /> MECNANICALCONTf�ACTOR MaILP� Gitt Z� PIION SiATF.II NSE• <br /> `1 Am r <br /> PtUNBINGCONiRPC R MA�L�DORE55 Cltt 21P PNONE $iAIELICENSE• <br /> CONiR�Gt PRICE OG WOPN <br /> ��G �— HEATING SYSTEM: �GAS f 1[LECTRIC f l _ <br /> DESCNI9E WORK PND SOUARE FOOTRGE INVOLV[U CONiACi�[RSON AHp PHON[NO <br /> — � � <br /> - - n - - ' - c�� � �� yl � — <br /> I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> rAorroseousE oF auuowc PROVISIONS OF LAWS AND ORDINANCES GOVERNIN6 THIS TVPE OP <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> ieceioescnianor+oFrnorEnnisNowneeiowoannncr+rwocor�Es� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior BIOCN or__ AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> . OTHER STATE OR LOCAL LAW REGULAiING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPE ��4J PE F E WORK FOR WHICH <br /> APPLICATION IS E AND '� OMP WITH THE STATE <br /> o�qce�Tax i.o.r+uusea CONTRACTORS LA 7827. � 29G2 WAC. /� <br /> CONSTRUCTIONLORNLENDER.ADbtiE55.TElEPHONENUMBEfi X / � �f� " � <br /> SIGNPTUR[ �Ai[ <br /> CITV BUSMGSS lIC[NSL NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—NFiNDLG UNITS—H.P. ! <br /> BATHTUB � FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> IAVATORY(WASH BASIN) HEATPUMP <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRVERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRYTHAY RANGEHOOD <br /> CLOTHES WASHER WATER HEATER <br /> URINAL WOOD STOVE <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS i GASFIREPLACE <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE <br /> GAS PIPING <br /> � ExHAUSTFAN � <br /> i <br /> i <br /> SUB TOTAL S � SUB TOTAL $ „�j � <br /> PERMIT 5 PERMIT S /�� � <br /> TUTALFEE $ � TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> fRONTSFiAACH PfAR5ET0ACK SI�ESETBef.N PI�NCII[CHNUMOfR fE[ RFf.fiPTNO <br /> L <br /> us[ioNe tor nnen vncnr�t sire FEES VALUATION FEE <br /> nv�s i�� No ounowc <br /> H[IGIII LIMiiAi10Y NO OF DWEILING SIZEOF BlDG4� <br /> UNIt$ PlUv91NC � <br /> — — I <br /> OCCUPANCV NO O�S��A'�f5 OCCUPANiLOAp BASEMENT kFOIANICnI � <br /> GRUUP <br /> ItYFS il NO <br /> 1'IqEAIARMREOT Rf�SOY �OOIIIONAI.PIANC�if.CN i <br /> _�__ <br /> nuien j <br /> rinrsrniNKiEaaea�o nen�oN <br /> srme ouiiowr,suncr�nnce <br /> tvreorr,oNst rinNsnrrnovennv CITYOfEVERETT runiie�ti�res <br /> LOCAL SALES --;`— <br /> �,a�E TA% CODE IS 3105 TO7AL <br /> —y—_ <br />