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APPLICATII,N FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDA!i STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOLI'fION fl COMBINATION fl BUILDING f� MECHANICAL tl PLUMBING fl SIGN <br /> PROJECT ADORESS <br /> /5 i U ,j?r�c i� C��. `� 4-(L4� <br /> �� A M�I�ADpRE55 Cltt Z�P PHONE <br /> vL /!a /f�ZK E'C.- Skrit� �i��L� ) �5�-/�,3L <br /> TEN�NT MqLI�ORE55 f.ITY ]IP PIIONF. <br /> ARLNITECTOROESIGNER M�IL�DOPE55 CnY )m PIIONF: <br /> GENEA(CONiMCI(V� M�IL�UORES���r/�� ��D/ /� ���� Nc M'��ylYrLG� ���F��mn, Y� <br /> AYlia�-T�n/ s� Sr.✓ /� � -�� '� �_ e a�.»�./ <br /> MECNANIC�L CONTpRGTOq M�IL.:ODRE55 f1TV 71������� STRTF.LICENSF� K Z/�U <br /> vJ <br /> PIUMBINGCONiR1CTQ1 M�CAbDRE55 CIN ZIP PIIONE ST�LELICENSE� <br /> GONiR�CT PRIGE OF Mqiyf�/7^ _ <br /> �%(j(� HEATING SYSTEM: f 1 GAS fl ELECTRIC �l <br /> OE BE K• �REfOOTAGEINVOLVE / CONTRCTPFPSON�NDPNONENO <br /> S i�C� - <br /> �L�c Lc�S <br /> I HEfiEBY CERTIFY THAT I HAVE READ AND E7(AMINED THIS <br /> rqoposeo use oF emipr+c APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPUEO WITH WHETHER SPECIFIED HEREIW f7'i <br /> LEGALDESCRIP110NpFP{ippEp7y�$�qyMgE�OWOR�RACHTWOCOPIES) NOL THE GRANTING OF A PERMIT DOES NOT P�ESUME TO GIVE <br /> �or BLOCK oF AUTHORITV i0 VIOLATE OR CANCEL THE PROvISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTIO . HAT I AM AUTHORIZED BV THE <br /> OWNER OF PROPERN TO FORM THE WORK FOR WHICH <br /> APPIIC ION IS DE AN I COMPLY WITH THE STATE <br /> PANCEL TA%10.NUMBER CGN ACT 5 LA 27 RC AND/2�� WAC. <br /> f // ryy <br /> CONSTRUCTIONIO�NLENOER,�00RE5S.TELEPNONENUMBER � ���� ✓ 3 f <br /> +N ME D�iE <br /> CITV BUSINFSS LIC�NSE N0. <br /> PLUMBINfi MECHANICAL <br /> N0. TVPE OF FlXTURE OR ITEM FEE NO. 7YPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILE� � NC—A/HNDLGUNfTS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) HEAT PUMP �— <br /> SHOWER � UNI(HEATERS—B.T.U. M � <br /> KITCHEN SINK 6 DISP ; CLOTHES DRYERS ; <br /> DISHWASHER VENTILATION FAN � <br /> LAUNDRY TRqV ; RANGE HO00 ' <br /> CLOTHES WASHER � WATER HEATER <br /> URINAL WOOD STOVE <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSEPT( OOD BUR ING) � <br /> BACKFLOW PREVENTERS ; GASFIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> GAS PIPING <br /> EXHAUSTFAN � <br /> � — <br /> � � — <br /> SUB TOTAL S ; SUB TOTAi S (pV 1 <br /> PERMIT S � PERMIT S �,.?�� <br /> TOTAL FEE S � TOTAL FEE S ��""; <br /> FOR OFFICE USE ONLY: <br /> iRONTSETP�CR PE�RSF.TO�CN SIDESF.TB�f.N PI�NCIIGCKNUMOfR fEG f1Ef.f:IPTnO <br /> usezor+e �otnnE� vnca+�sire FEES VALUATION FEE <br /> IIYES fi NO � <br /> i ounniria � <br /> MEIGNT UMITATION NO OF OWELLING SIZE Of OLOGrt I i <br /> UNII$ pLUM01NG <br /> I I <br /> OCCUP�NCY 1q 0[SION16 OCCUPANiL0�0 B�SEINENT � <br /> GRDUP MFCIInNICAI. <br /> I fIVES 11 NO — -- <br /> FIREAURMREO'p RF�50\ ApfllllpNALt'I.ANC�ifCN <br /> O1MER <br /> FIRF.SPRINqERPFO� RERSON —i <br /> SiAIE 01111 DIYG SURq1ARGE <br /> i <br /> trveorror+sr rinrusnrrnovEom L;TyOFEVERETT i�unnr.wonres <br /> LOCAL SALES -- — - — — <br /> on�e TAX CODE IS 3105 TOTAL <br />