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� ^ <br /> APPLICATIOir! FOR CONSTRUCTrON PERMIT� <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> fl DEMOLITION f 1 COMBINATION b� BUlLpING f� MECHANICAL r 1 pLUMBING f 1 ,^a1GN <br /> PROJECTADDRESS _ I� / �✓� G���� � <br /> 5 /l I^�/�'VG✓ V <br /> OWNER MAIL�OORE55 dTv ZiP PHON[ <br /> Mrs .)GANG'r,alAm s» ,vv�l,.Ar� � ��rao� 7-s 2 -977�' <br /> TEN�NT A��iL�DDR.'S5 GTY ZIP PHONE <br /> AqCMITF.CTOR0E9GNEq M�II.�DORE55 GTY 71t' PNONF <br /> �GENER CONTMCtOq MRII��DRE55 CIIV iiP f'H04[ ST�iC.11G[NS[� <br /> k'oe ,f /1I-75 '��AYL S� L�vr,=rl� ir�yoh��/B3 LeNs�� c�s�G�G� <br /> MECNANiC�LCONTRACTOR MAIIADDRE55 f.liV Z6' PIION[ StAfELICENSF.� <br /> PLUMBINGCONTR�f,iOq M�IL�DDRES$ CItV ]iP PIIONE STAIEUCENSE• <br /> CONIMCT EOFWOPN <br /> !,� O`� HEATING SYSTEM: f 1 GAS �l ELECTRIC I� <br /> DESCRIBE M/ORK AND SOU�RE FOOTAGE INVOIVED CONTACT FF.FSON�ND?HONF.NO <br /> �'�r�/l/�f+N C,! e� '� <br /> 1 HEREBY CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION ANU KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROPOSEOU�E OF BUILDIN PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> S/ C�� WORK WiLL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAL/D'ES�CR'IP�T�I�ONOF RTY�SMOWNBELOWORATi�GNTWOCOP�E51 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or�L1LL eiocK 112u or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE <br /> PEHFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPI.ICATION IS MADE AND 4 COMPLY WITH THE STATE <br /> OARCFLT�%ID.NUMBER CO TRACTORSlAW18. RC1 At�296200WAC. <br /> �� � <br /> Y97/-o�0�1 1/y-o ; y � /-- <br /> CONSiRUCTON LO�N IENDER,�ppRE55.TELEPHOYE NUMPEfi x� U � �(���/� �7 <br /> S�GN�TI E O�TE <br /> Cltt BVSMF.SS I.ICENSG NO. <br /> p�p��y MECNANICAL <br /> NO. TYPE OF Fl%TURE OR ITEM FEE NO. T'PE OF E4W IPMENT FEE <br /> WATER CLOSET(TOILET) IVC—AMNDLO UNITS—H.P. <br /> BATHTUB � FORCED Alfi SYSTEMS—6,T.U. M E.A. � <br /> LAVATORV(WASH BASIN) HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M <br /> KITCHEN SINK 8 DISP � CLOTHES DRVERS � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRYTRAV ' RANGEHOOD i <br /> CLOTHES WASHER WATER HEATER <br /> URINAL ' WOOD STOVE <br /> ORINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKROW PREVENTERS ; GAS FIREPIACE � <br /> SINK(SERVICE—BAR,ETC.) GAS IiANGE <br /> GAS PIPING <br /> � E%HAUSTFAN � <br /> i ' <br /> i <br /> SUB TOTAL E � SUB TOTAI. E i <br /> PERMIT $ i PERMIT S � <br /> TOTALFEE 5 ' tOTALFEE E <br /> FOR OFFICE USE ONLY: <br /> fRONiSFTP�CR REA�SFTP�CN SIDESEiB�CN PI�NCIIECN A[R fF[ RFCEIPiNO <br /> �o _ <br /> use zor+e ior�nen vnc�r+r srte FEE VALUATION __ FE=_r_ <br /> nvcs i� No nunnn+r, �j� __� � _ <br /> I <br /> HEIGIIi11MIT�TION NOOfUWELLING SIZEOIflIfH:�I <br /> UNIiS PLUMIIMG <br /> _ � <br /> I <br /> OGCUP�NCY NOOi�l0ui6 OCWPANILOAU PRSEMENi kEC11nNICRI. <br /> GROUP — - -- <br /> I1YF5 i� NO <br /> FIRE�URN REO'C1 RFRSON Ap0111pNP1.PI AN CHff,N � <br /> _ _—i— _ <br /> i <br /> OtME� <br /> FIRF51`RINNIkAAF0�0 AF�FON j, <br /> SiAtC OUIIOMG SIIRf,MAqGL ��Sv <br /> rmeorr,orusr rinNsnrrnovFnov CITYOFEVERETT rurucwonKs _ <br /> LOCAL SALES -- � � <br /> ��q�E TAX CODE IS 3105 TOTAL __ "� 'S <br />