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.- <br /> APPLICATIt,.� FOR CONSTRUCI .ON PERMIT(//�� <br /> CITY OF EVERETT• BUILDING DIVISION �./ <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •25°-8810 <br /> fl DEMOUTION fl COMBINATION �f%�UILDING I 1 MECHANICAL ' PLUMBING f l SIGN <br /> PROJECT ADDRESS <br /> 93.s' sGa��� wz� <br /> owNEn MRILpooRESS C�iV 7ir rNOu[ <br /> CJ,i„��,., � G� � � ��yrrL�s..7 y9 3� SeLvic..J �a y C✓T 9�Zo'3 3Y8--f!�l J <br /> TEN/NT I IIAII.ApDRf55 UiY ]Ip PIIONE <br /> ARLNIT[C70ROESIGNEN IAAILpDORE55 QiY ZIP PHO4E <br /> GENE{lILCO4BiAC10R MaIIADDP[55 QtY ]iP PHONf: S�ATEIIC[NSE• <br /> D��.R. <br /> �'ECNANICnI CONTRACTOR MAIL AO�RE55 Cltt LP PHpNE STATE I ICEN$E� <br /> PLUMBINGCONTRACTOR NAIL�DDPESS QiY 7�P PHO'�E STAiELICENSE� <br /> CONTRRCT PRICE OF WORK <br /> HEATING SYSTEM: x'GAS f-1 ELECTRIC f"l <br /> DESCRIBE WORK�YU SOUAPE fOOTAf,�INVOLVED CONTACT PERSON RND nqOH[NO <br /> e - .,s..:.... --b.- � N Cti ..� � � -� - <br /> 2Gr <br /> I HEREBY CERTIFY THAT I HAVE FEAD AND EXAMINED THIS <br /> APPUCAiION ANU KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSF.OUSEOFBUILDING PROVISIONS OF LAWS AND ORDINANCES GOVERNIN(i THIS TVPE OF <br /> N�ORK WILL BE COMPI.IED WIT4 WHETHFR SPECIFIED HEREIN OR <br /> �eG�ioesc iPngorvoFanoremvlsr+owwee�owoannncr�Twocoaies NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or y 7 e�ocK�_or � G AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF GONSTRUCTION.THAT I AM AUTHORIZE�BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> PAFCELTA%I D.NUM9ER CONTRACTORS LAW 7827 RCW AND 296 00 WAC. <br /> ���� " �C7 � i.i_�.. " -� �.���• /� <br /> CONSTRI/CPON LOAN LENUEq.RUDPE55.TELEPHONE NUMBFq x �� �� L y—J�J <br /> _ SIGhATURE � / D�TL <br /> � <br /> GTV�USINE55 UCU�SE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE 0. TYPE OF FI%TURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. � <br /> BATHTUB � FORCEDAIRSYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) AT PUMP � <br /> OWER ' UNI EATERS—�.T.U. M <br /> KI? EN SINK 8 DISP i CLOT S DRVERS i <br /> DISHW HER � VENTILAT N FAN <br /> LAUNDRY AY ; RANGE HOO i <br /> CLOTHES WA ER � WATER HEATER <br /> URINAL WOOD STOVE <br /> DRINKING FOUNTAI METAL FIREPLACE(W D�URNING) <br /> FLOOR DRAIN FIREPLACE INSERT(WOO URNING) <br /> BACKFLOW PREVENTERS � GASFIREPLACE i <br /> SINK(SERVICE—BAR, ETC.) GAS RANGE <br /> � GAS PIPING <br /> [Xl1AU5T FAN <br /> — i <br /> T <br /> SUBTOTAL $ � SUBTOTAL 5 � <br /> PERMIT 5 PERMIT $ <br /> 1�OTAL FEE 5 ' TOTAL�EE 5 ' <br /> FOR OFFICE USE ONLY: l� , LoU <br /> FRONTS[�AACK � REARSETCI9[N�/ SiDESETPAC� � PL�NCII[CN�1W1/F� �F! ,� REC[It�TN%�� <br /> � G �.j � �6ri�— <br /> use z e � �ornaea vneaui srte FEES VALUATION FEE <br /> �� nvFs n r+o em�oiNc p �-��� I G(� <br /> NEIGNI UMI1nT10N f UO'Of OwFLUNG SIZE OF BLWrtI � <br /> .�G S ��„�r��N� � <br /> OCCUPAYLY ND OfSiCAIES OLCUPANTLOAD 9ASEMENi M[CMaNiCAL i <br /> �a ur / "� <br /> _ �.. IlYES -, NO � <br /> FIPE�LARM REO'D REASON ADDIiIONAL PIAN CH[CR <br /> i <br /> N � OTNER � <br /> FIRE S�RINKLER PEO'D RF.PSON � <br /> N� STAT[OUILDI4G SURGIARG[ � �=_l <br /> TYPEOPCUN57 vtnNsnrr veoer CITYOFEVERETT runucwor+Ks 1 - <br /> j ./'��A_. LOCALSALES — � � <br /> �/ —h� onre � 2—� -SS TAXCODEIS3105 TOTAL /��,i���_i.� <br />