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APPLICATI(1! FOR CONSTRUCZ �DN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> ❑ DEMOUTION fl COMBINATION fl BUILOING ❑ MECHANICAL � PLUMBING Cl SIGN <br /> PROJECTADDRESS 1 Lt 1z RU,C-I<P� R Ve- EVP�Gf{' ' WA <br /> OWNER MnILAODR SS Cltt ZiP PIIONE <br /> Rick�.halk0. l9lZ Kurku—f}v� Ev���t q�2D( 339 366$ +ro s3�-szsv wc <br /> IENANT MRILADORESS GTV ZIP FNONE <br /> �RCHIiECTORDE5IGNEP M�ILADORE55 Cltt ZIP PNONE <br /> GENERALCONiRACTOR M�IL�DDRE55 CITV )IP PMONE SUTEl1LEN5Er <br /> MECMANICALCONTRACTOR MM�AODi7E55 CITV 71F PHONE STRTELILENSE� <br /> PIUMBINOCONTRICTOR M�IL�DDRE55 Cli� ZIP PNONE ST�TELICENSE� <br /> ow ne+- <br /> CONTPACT PRICE OF WOIiK ' <br /> HEAT� ING SYSTEM: ❑ GAS ❑ELECTRIC ❑ <br /> 1(�OESOCPoSE WORK 11N0 SOUARE FOOTAGE�NVOLVED , COi!TACT PERSON ANO PHONE NO. <br /> �T 1� l0.GLmG,�'� Yn0.i.� w.�,.{-G� ��ne <br /> INTD ' nc. �OKSG {TOM �� $�7�G�-} <br /> V�1/G- �- W1oUL 0.n 2�f�sf'�� IG.yctfo� � HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BNLDIN6 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � S F /Z PROVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS TVPE OF <br /> WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�LDESCRIPTION OF PROPERTY(SNOWN FELOW 0{i RTTA�H TWO WPIES) NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME TO aIVE <br /> �or e�ocK _oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REODUITINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTNORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATc <br /> PARCELTN(I.D.MIMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUCTIDN LO�N LENCER.ADDRESS,TELEPHONE NUMBER X � ���— !I` 3—/'] <br /> SI �TURE 011TE <br /> CITY 6USINE55 UCENSE NO. <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FlIRURE OR ITEM FEE NO. TYPE OF flXTURE OR ITEM FEE <br /> � WATER CLOSET(TOILE� � A/C—AMNDLG UNITS—H.P. � <br /> BATMTUB ; FORCE�AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) �� HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M <br /> KITCHEN SINK 6 DISP ; CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> UUNDRV TRAY RANGE HOOD ; <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL � WOOD STOVE ' <br /> DRINKINO FOUNTAIN ; METAL FIREPIACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFIOW PREVENTEFS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE � <br /> Ma� '�utct �f ' GASPiPING ' <br /> � EXHAUSTFAN � <br /> � � <br /> i � <br /> � � <br /> � � <br /> SUB TOTAL S � i SUB TOTAL S ' <br /> � <br /> PERMIT $ �� � � PERMIT 5 � <br /> TOTAI FEE S � � TOTAL FEE 5 ' <br /> FOR OFFICE USE ONLY: <br /> FPONi5E1B�CR RERR SETAACN SIDESETBACK PIANtHCCK UMAER FEE RECEIPTNO. <br /> (v// e� <br /> usezoae iornne� vncnNtsiTE FEES VALUATION FEE <br /> nves n r+o euaoir+c � <br /> i <br /> MEIGHTLIMITIITION NOOFDWELONG SIZEOFBLDGRI. i <br /> UNITS P�UMOING � <br /> OCCUP�NCY NO OFSTOPIES OCCUPRNTLOAO 6ASEMfNi i <br /> GROUP MECNAhICAL � <br /> ❑YES 1� NO � <br /> FlRE MARM REOV RELdON ADUITION�L PUN CHECK i <br /> OTMER � <br /> i <br /> FIRE SPRINNLER REO'D REASON i <br /> STAiB BUILDING SURCHnAGE I <br /> TYPEOFCONST. PUNSAPPROVEOBY CITYOFEVERETT PUBLICWORNS � <br /> LOCALSALES � <br /> DAiE TAX CODE IS 3105 TOTAL � <br />