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APPLICATI�.N FOR CONSTRUCI iON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION fl COMBINATION la'�UILDIN(3 ❑ MECHANICAL n PLUMBING " SIGN <br /> PROJECTADDRESS �'K <br /> �afS2u�SG2 �VClz�';� <br /> OMMER MRIL�WqESS Cltt ZIP PHONE <br /> J,�O• FaL��Nti x�o So,Mavisen Mo � oz AFi�L 360 �4� wF��' <br /> TENANT MAILADpHE55 CITY 21P PHpNE <br /> ✓' <br /> �HLMiIECTORDE5IGNEH M�IIADDqE55 CITY ZiP PHONE <br /> dRMG <br /> GENER/LfpHTR�CTOR MAILpODRE55 CiiY 2iP PHONE SfAtCI�C(V�E• <br /> iuw:u..,,�n„i c. *„raanc �u�cOF? / ib y'pOu�, 4oA0 �di Z ''T 4� $ /t r c � 7 C <br /> �dELH�WICALCONTR�CTOR M�II�DDRE55 CiTY ZIP PIIONE ST4TEUCEuSE� <br /> FLUMlM6CONTR1piOR M��L�DDRESS pry 21P PHOHE STATEUCENSE• <br /> CONiR�CTPRICE OF Wp{IN <br /> �i,00o HEATING SYSTEM: fN' .�.AS r1 EIECTRIC � <br /> DESCRIBE W�7i1K�NU SOUARE FOOTA6E MVOLVEO CONT�CT PERSON�ND PHONE NO <br /> r PJ� ic.-I n� f-ouNopY.n ,U, Fot- �nit �Lc 7 � y �c�e <br /> � HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PIqPO5EDU5E OF BUILOINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC7 ALL <br /> PROV�SIONS OF�AWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEO�LOESCMPfIpNpiVRpPERtt(SNOWNBELOWOqATTAGHTWOCOPIE51 NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �Or 7 i A! e�ocK i�N oF ��� e�+ AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT�AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> vMCE�iuc�t�D/.,r��uy/��n ����� CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> -��=_ ?7 � !�% \ <br /> GONlTIIUCI1qN10�NL�NUf:R,�tNInESS.TElEM10NENUMEEII X y},,.,A,�,__ � . ��1„,.-. IL - � -4i <br /> Sldl�TURE p,1iE <br /> CITY MISINE55 LICENSE N0. . <br /> PLUMSINp MECHANICAL <br /> NO. TYPE QF Fl%iURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET�TOILEn � A/C-AMNDLOUNITS-H.P. <br /> BATHTUB � FORCED AIR SVSTEMS-B.T.U. M E.A. <br /> UVATORV(WASH BASIN) , HEAT PUMP <br /> SHOWER � UNITHEATERS-B.T.U. M <br /> KITCHEN SINK 6 DISP CLOTHES DRVERS <br /> DISHWASHER VENTILATION FAN <br /> LAUNDRVTRAY ; RANOEHOOD <br /> CLOTHES WASHER � WATER HEATER —�— <br /> URINAL WOOD STOVE <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) <br /> FLOOR DRAIN � FIREPUCE INSERT(WOOD BURNWG) <br /> BACKFIOW PREVENTERS ; OASFIREPLACE <br /> SINK(SERVICE-BAR,ETC.) OAS RANGE <br /> GAS PIPING <br /> � E%HAUSTFAN <br /> � <br /> � <br /> SUB TOTAL S � SUB TOTAL S <br /> PERMIT E i PERMIT 5 <br /> TOTALFEE E � TOTALFEE 5 <br /> FOR OFFICE USE ONLN: <br /> FRONTSETB�CN EMSETB�CK SIDESET6�CK PlARC11ECNNUMBEN FEF AFCfiniNO <br /> � a�� <br /> USE 20NE iot enE� v�c��+r sire FEES VALUATION FEE <br /> f1YE5 �i NO �— <br /> ewioir+c � G v <br /> MEIGHT UMIT�TION NO OF DWEl4N0 SIZE OF BIDGT — — <br /> UNIfS •.��; S� /AQVN P�U6�BING — y— <br /> C J _F_ <br /> OC'Cq.CUp�NCY NO Oi Sf0aiF5 OCCUP�Nf LO�D B�SENENT MECH�NiCAL <br /> .3 1 N A iires n �o -- <br /> FlRE�L�RM REOD�' � RFASOY ADO�iIONAI O�AN GNFGK <br /> --�...__"."_ <br /> OIHEN <br /> FIRFSPRINKIERREO'D Rf�504 -- —'-- <br /> STATE DIOIDMG SV�C��nRG� <br /> TYPEOFf,pNST PI�NSAPPfIpyfDBV CITYOF [VERETT �1191If.WORKS - -- - i-- <br /> /'! :�v Ji� LOCP'_SALES <br /> y� ��TE IZ I RS TA%CODE IS 3105 TOTAL __ _ <br /> � <br />