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APPLICAT�L.� FOR CONSTRUC7 .AN PERMIT <br /> CITY OF EVERETf• BUILDING DIVISION � <br /> 3200 CE.DAR STREET•EVERETT. WA 98201 •259-B810 <br /> f7 DEMOLITION f 1 COM9INATION f� BUILDING J� MECHANICAL I� PLUMBING fl SIGN <br /> PROJECT ADDRESS SI�� S�d .1 ✓✓S/ <br /> o D Maaaounes� cm nr r��oNe <br /> av�.� �q'�• �u s%;r ,scw �i v►'s7� tLc�'� qp�e 3 ,�s'P-/3 s� Ckso r �t'� <br /> IENANT MAlIAppRF55 CITV ]iP P�IONE <br /> ARCNITEGTORDESIGNCR MAILADpRE55 �ITV :iP PHONE <br /> GENEPIILCONiRALiOR MAIL�DDRE55 CIiV 71P PHONE STATELILENSE� � <br /> MECHANILRICONTR4CTOR MnILA�DRE55 CI7V 21P PIIONE STATEULENSE� <br /> f)»!rv'�cdh,ao �!!i. JCe4 /3ioao%w �"✓crr,yy qP�o/ �/l•�t�-��c A/i'E/1/:ik S+'�.�y <br /> PlUMBMGCONTRACipR MAILApORE55 CItV 21P PI!pNE ST�TELICENSE� <br /> CONTIi11CT PRICE OF WORN <br /> � � S G HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> pESCRIBE VIJfiK AND SOU�RE FOOT�GE INVOLVEO CONTACi PERSON RNO PNONE NO. <br /> �.!/fY L� N.wa c Au � 1� H.� L1�7�!/7 T.►. � <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> 1'ROPOSE�USE OF BUILDINCa APPI�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> V�ORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> lE0�L0ESCRIPTIONOFPROPERTV�SMOWNBELOWORRTT�GNTW�COPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocK oF AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATIN�CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> �WNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> /�PPIICATION IS MADE AND I COMPLY WITH THE STIITE <br /> PMCEL T/J!I.D.NVMBER CONTRACTO lAW 1827 RC ND 29G.@00 WAC. <br /> CONSTRUCTON LO�N LENDER.�DOPE55,iEIEPNONE NUAIuER Y CJ� I-/ ( `y <br /> SIGNATURC ���_ ^ D <br /> K <br /> CITY BUSINESS LICENSE NO. <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OP FlXTURE OR ITEM FEE NO. TVPE OF FlXTURE OR ITFM FEE <br /> WATER CLOSET(TOILET) � A/C—NFiNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP i <br /> SHOWER UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CIOTHES DRYERS � <br /> DISHWASMER � VENTILATION FAN � <br /> LAUNDRV TRAY ; RANGE HOOD i <br /> CLOTHES WASHER WATER HEATEF � <br /> URINAL WOOD STOVE ' <br /> DRINKIN4 FOUNTAIN i METAL FIREPLAGE(WOOD BURNING) i <br /> FLOOR�RAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENiERS ; �ASFIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) 6AS RANGE <br /> ' GAS PIPING <br /> i i E7(HAUST FAN <br /> � � <br /> SUB TOTAL A � SUB TOTAL S O ' <br /> PERMIT $ � PERMIT S /� � <br /> TOTAL FEE E ' TOTAL FEE S ��' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBRCN RE4P 5FT9Af.K SIDE SETBRCK �IAN CHECN NUMOER F[E RECEIPt NO. <br /> ��l C' <br /> use ior+e ior aer.� VACANT SITF. FEES VALUATION FEE <br /> nrrs n r+o em�owc � <br /> 1 <br /> NEIGNT LIMRATION NO.OF OWELLING SIIE OF HLM�� I � <br /> UNITS PWMOi4C <br /> OCGUPA4CY NO OISi0AIC5 OCCUPRM L04D BASEMENT MECMGNICRL � <br /> GROUP <br /> fIYES fl b0 � <br /> FIREALARMREO'D RERSON ADOITIONRLPLANCNECK I <br /> OTNEP � <br /> � <br /> FIRE SPRINNLER REOD RE�SON � <br /> STUE Bl1�LDING SURCIIARGE � <br /> TYCE OF C9N57 PLANS APPROVED BV CITY OF EVERETT PUBLIC WORNS � <br /> LOCALSALES <br /> DA7E TAX CODE IS 3105 ioTAl I <br />