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APPLICATIG.� FOR CONSTRUC7 .JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> rl DEMOt.ITION fl COMBINATION f-1 BUILQING f�MECHANICAL r l PLUMBING fl SIGN <br /> PROJECT ADDRESS /�(;/ /JU«/� ' ��� ♦ <br /> ,C <br /> OWNER M�ILADDRESS CItY :IP PNONE <br /> Ck;"sr�-t Jc����v /%G/ �����,�� �✓ti�'c=�T 9�'Z�'/ ��z-�zs s/ <br /> IEN�NT MAILADpfiESS CITY / ZIP PMONE t <br /> ARCNRECTOP�ESIGNEP MMLADDRESS Cltt ZIP PHONE <br /> GENEMLCONTfInCTOR M�ILAO�RE55 CIIY ZIP PIIDNE STATEIICENSE� <br /> MECM�NIFAI.CONTRnC70R MAI�AODRE55 CI7Y ZIp PUONE STATELICENSE� <br /> ��. <br /> PWMBINGCONTRap10R M1ILADDHE55 CI1Y ZIP pNONE STATELILENSE/ <br /> C NTRACTPRICE�FWORN <br /> , � , � HEATING SYSTEM: f�GAS fl ELECTRIC fl <br /> DESCRIBEWORNANOSOU�REFOOTAGEINVOWE� CONTACTPERSON�NOPNONENO. �^ /�C(,,✓J �l'7 S�/�/ <br /> ��J� C 7 L <br /> I��Si�r�� %�Cl',�I ��Il,� v�f}C� � <br /> �� �/{-V ,•�V� I HEREBV CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> �AOPOSED USE OF 9UILDINO APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> ��.'�_ � PROVISIONS OF LAWS AND ORDINANCES GOVEfiNING THIS TYPE OF <br /> � WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRIPTIONOFPROPEFTY�SNOWNBEIOWORAR�CMTWOCOPIES) NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT� e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATIN(i CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.D NIIMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> �/)� �� j\ r <br /> CONSTPUCTION lOM!LENDER,/�DDRESS.TELEPNONE NUMBER i�l'I�1 J- / !�.- . �—/�`�/ <br /> SI �TU / O�TE <br /> - CITY BUSINE55 LICENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) � q/C—MiNDLOUNfTS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 6 DISP � CLOTHES DRYEHS ; <br /> DISHWASNER � VENTILATION FAN � <br /> LAUNDRYTRAV � RAN6EHOOD ' <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPIACE ' <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE �— <br /> GAS PIPING <br /> i EXHAUSTFAN � <br /> i i <br /> SUB TOTAL S ; SUB TOTAL S � <br /> PERMIT $ i PERMIT S �— <br /> TOTALFEE S � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> lRONT SETPACR PEAF SETB�CN SIDE SETB�CN PUN CIIECK NUNBF.P FEE RECEIPT NO. <br /> 5!�31G'� <br /> uSeioNE �ornnen VRCRNISIfE PEES VALUATION FEE <br /> — fIYES 1iNO pllllDiNf i <br /> i <br /> IIEIGIIT LIMIT�710N NU OP UWELLING 512E Of OIUG/11 ' <br /> UNII$ <br /> PIUMpMG <br /> OCCUPANCY NO Of510aIE5 OCCUPANTL04D 9ASEMEN7 4 <br /> GROUP M[CNPNICRL � <br /> IIYES II Np - ' <br /> � <br /> FIRE�UPMFEO➢ fIfASUN PO�If10NPI.PI.ANG1[f.N <br /> —�— <br /> OIHER <br /> FIRF.$PRINRLERREQ� I1FACON � <br /> i <br /> sTm[amtoivr,s�mr,nnnce <br /> rvPEovr,or+si r�nNSnrrnovennv CITYOFEVERETT runi.icwonKs <br /> LOCALSALES — <br /> uATE TAX CODE IS 3105 TOTAL <br />