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� APPLICATIOr�I FOR CONSTRUCT�ON PERMIT� <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> fl DEMOLITION fl COMBINATION fl BUILDING fl lAECHANICAL r� pLUMBING �l SIGN <br /> PROJECT ADDRESS <br /> l3 /S- l�vc/��/L /��/Gs� <br /> OlN1ER M�IL�ODRESS Q '/ CITV 21P PHON[ <br /> qFjU(J/1� ��/�� n ���� A�l�'�C�Q[J�/XS. �KGLL'+y' z_r9- z3�6 <br /> lEN�NT MAILMIW1F55 CIiY ZIP CIIONE <br /> �PCHITEGiOR0E5�GNER M�II�DDRE55 Cltt IIP PHONF <br /> ri,qr Fy T� ,v�.Pe/�,�fi���. /36/6M6��i,�i,r�/ ��.d_%�9l 5.��0�_ Zd6-_7l,l2�� <br /> GENER��RRCTOR MMLIIWRE55 CIiY� .�, PIION[ SfAiEIICEN�E� <br /> O7'7�h' <br /> MECM�NICRLCONTP4CTOA W��I.RWRESS CITV ZIC PIIONE SiATELICF.NSE� <br /> 1'IUMBINGCON7'Uf,TOR M�ILADDRESS �ItY ZIP PHONE STQELICENSE� <br /> CONTMCTPRICEOF WOAN `V / HEATING SYSTEM: I 1 GAS rl ELECTRIC f l <br /> pESCRIBEWO{IKANTU. WREFWT�GEINVOLVED/ CONiACTPF.R50NANDPHONENO <br /> N'LTw /�w,r�1' ��Z/lLC�i ����,.'� <br /> � _ � <br /> I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> APPUCATION AND KNOW THE SAME f0 BE TRUE AND CORRECT.ALL <br /> Mql'OSED VSE OF P�1ILOING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> . WORK WILI BE COMPUED WITH WHETHER SPECIFIED HEFEIN OR <br /> IEC�LDESCRIP110NOFfMiOPERtt�SNOWNBEL Twocovies� NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT� BlIX"( AUTHORITV TO V�OLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGUUITINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOHIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WH�CH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAHLEI TNf I.D.MIMOER CONTRACTORS LAW iB27 RCW AND 296200 WAC. <br /> CONSTRUCl10N lON!IENDFR.�OORESS.TEIEPHONE MIMBEP X .(�..(� f� /��p � /� <br /> _.� <br /> 51 iURE D�TE <br /> �t,y1'(b'8077 QP <br /> CITY BUSINESS UCENSE NO. <br /> p�UMlIN6 MECHANICAL <br /> NO. TVPE OF Fl%TVRE OR ITEM FEE NO. 7YPE OF EOUIPMENT FEE <br /> WATERCLOSET�TOILEn � A/C—NHNDLOUNRS—H.P. ! <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> UVATORY(WASH BASIN) HEAT PUMP � <br /> SHOWER UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRVERS <br /> DISHWASHER VENTILATION FAN � <br /> UUNDRY TRAV ; RANGE HOOD � <br /> CLOTHES WASHER i WATER HEATER <br /> URINAL WOOD STOVE ' <br /> DRINKINO FOUNTAIN i METAL FIREPLACE(WOOD BUFNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKROW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE �' <br /> GAS PIPING <br /> � EXHAUSTFAN i <br /> i <br /> i � <br /> SUB TOTAL E � SUB TOTAL S � <br /> PERMIT S � PERMIT S � <br /> TOTALFEE S TOTALFEE S � <br /> FON OFFICE USE ONLV: <br /> fRpJTSFTpACK RF.A�SF.IBACN SIpESETP/CN 1'lMlCIRCN�lIIMOFR f[E AfCEiPiNO <br /> usezoNE ior�nE� wc�Hrsrte ES VALUATION FEE <br /> nves n Ho �unnwc: �' <br /> HEIGNT UMITATION NO OF DWELIING SIZE Of HlOG41 <br /> I1NIiC PIVM�INO <br /> —� <br /> OCCUP�NCV tq!x90�[5 Q:CUPRNTlOAU BRSEMENi M[CIIANICAL ' <br /> GROUI' <br /> I1vE5 �INO <br /> FIRE�LARMREO'❑ PF�SON P[1pIIlON�I.PUNC11(CK i <br /> --i— <br /> ou�en <br /> FIRFSPRINNLFRREO� AF�FON <br /> SialE oUM1DivG SURCNnnC.E �h/1 <br /> v1[ <br /> tvvEovcor+sr rinNServrovEo9v CITYOFEVERETT num�r.won�s <br /> LOCALSALES — <br /> ��,E TAX CODE IS 3105 TO7AL _ _ � �,�� <br />