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APiPLICATI�,.� FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION �C,��� <br /> 3200 CEDAR STREET• EVERETT, WA 98207 •259•8810 <br /> f� DEMOLITION I-� COMPINAiION I1 BUILDING I1 MECHANICAL f-1 PL�IMBING Il SIGN <br /> PROJECT ADDRESS � <br /> IU1� lf.le.�rnc�s� �v� <br /> OWpNEA 1 � rlA(1�LnDORF.55 n CItt ZiP PMONE <br /> L.('iLKSr�Y� {,CLC�t° Y.O. {�<',X �?�`.�_ �V`�fY_'�-� q�5'a(��n ,��r�--��f� <br /> TENANT IdAll.AppRG55 CIIV ]IP PIIONE <br /> RRCHItCCTOPDE51GNEq MAl1.qDORE55 CITY zIP PHONE <br /> GENERaLGONTRACTOq MAILRODRESS CI1V pIP PIIONF. STATELICENSE� <br /> o���ne� <br /> MECHnNICALLONIRnCTOR MAILADDRE55 CIiY ZIP PIIONE STATEI.ICENSE♦ <br /> PWMBINGCONiRnC70R MAILAD�RE55 GTY ZIP PHONE SiF1EUCENSE� <br /> CONiAACT FRICE OF WORK <br /> HEATING SYSTEM: f l GAS f-1 ELECTRIC fl <br /> OESCRIBE WORK�ND SOUARE FOOTPGE INVOLVED CONTACT PERSON�NO PMOYE N0. <br /> f�P—fOc�� I� .. C, V <br /> I HEREBV CERTIFV THAT I HAVE READ AND ExAMINED THIS <br /> vnOroseo use F em�ort+c APPUCATION AND KNOW THE SAME TO BE THUE AND CORRECT.ALL <br /> S PROVISIONS OF LAWS AND ORD�NANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITN WHETHER SPECIFIED HEREIN OR <br /> LEGQOESCRIPTIONOFPP.OPERtt(SHO\YNBEIOWORRTTACMTWOCOPIE51 NO7. THE GRANTING OF A PERMI7 DOES NOT PRESUME TO GNE <br /> �or ai.ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCA�LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWVER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION �S MADE AND I COMPL'! WITH THE STATE <br /> PRRCEI TA%ID.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> '��t�-`t - aiss - �oG -ovoo �z�.�, �j <br /> GONSTRUCTION LOAN IENpER.�ODRE55.TELEPMONE NUMBER L _ S�J —� <br /> SIGNATURE OAtE <br /> CITY BOSMESS LICENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—4MNDLG UNITS—H.P. � <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) i HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8�ISP � CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNORY TPAY RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL � WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN FIREPLACE INSERT(WOOD BURNING) <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE <br /> GAS PIPING ' <br />� i EXHAUSTFAN i <br /> I � � <br /> SUB TOTAL 5 � SUB TOTAL $ � <br /> PERMIT $ i PERMIT 5 � <br /> ---�— <br /> TOTAL FEE $ � TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETpRCN RfARS[T[iACK SIDESETOACK PL4Nf11[CI(N1N�f. .� F[E F[LEIPTNO. <br /> L <br /> us[zone LOTARER VACANTSIiE EES VAWATION FEE <br /> n vEs n r+o ominiHa j <br /> 11EIUMTLIMITRTION NDOFOW[LLING SIZEOFOLDGRI <br />, UNIiS PLUR101YG i <br /> OCCUP4NCv NO Oi510PIE5 OCCUPnNTLOnD BASEMENi <br /> GROUP Mf.C11nNICAt � <br /> f1VE5 fl NO � <br /> FlREALARMREOD q[ASON A�OIt10NAlPLANCMEGK i <br /> OiH[R � <br /> i <br />. FIRE SPfiINKLEP B[OD REASON <br /> STAiL OUILDMG SURCIIMGE i <br />� � tmeoFcoNst r�nHsnvP�oveoov CITYOFEVERETT ruour.wonKs ; <br /> LOCALSALES <br /> oatE TAX CODE IS 3105 TOTAL i <br />� <br />