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�-. <br /> � <br /> APPLICATION FOR CONSTRUCT�JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, `NA 98201 • 259-8810 <br /> f7 DEMOLITION (l COMBINATION � BUILDING I�MECHANICAL f� PLUMBING fl SIGN <br /> PROJECT ADDRESS I�, w, ' li�J(.7 M nG-'T /III � \I- `i �"' -�G' � <br /> 7� tt <br /> OWNER MnILA0�RF5S ��ty ZIP � .PHONE <br /> G�r���l �,�A�Jn.��T i�n �i1;-Mc�r- /�i� �i�tic� 77� 9�'�Q/ �a ;- �.��� <br /> IENANJ MRILAODRF.SS � CITY ZIP PIIC4E <br /> ��M C <br /> ARGNITECTORDESIGNER MAIL��OREJS qry p�p pH7HE <br /> GENEqA1�CONTP�C MRILRDORE55 ���� � <br /> CITV ZIP ��' ONE $T�TE L�CENSE� <br /> ' �� t"r�' I�«T� �Y�n 7Na;�,�1P��r �� �l���i l�l�tl��.� N��.� �,Z <br /> MECHl1NICAL CONTqqCTOR MAI �DDFE55 ITY 21P PHONE �iATE LICENSE• <br /> PLUMBING LONTPACTOR MRIL qU0RES5 dtt ZIP PHONE STATE UCENSE� <br /> CONTR�CTPRICEOFWORN • <br /> � Q — HEATING SYSTEM: �GAS ❑ELECTRIC ❑ <br /> DESCRI E WORK AND SWARE FOO FGE IN LVED CONTR PERSON AN�GHONE <br /> � � =u �. c1� - _ <br /> -� < c – , r' � '� <br /> , � <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TNIS <br /> PROPOSED USE OF 9UILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�l0E5CRIPT10NOFPROPERTY�SNOWNBfLOWIXiATTpCHTWOCOPIES) NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br /> tor BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CON CTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS P E TO P RM THE WORK FOR WHICti <br /> APPLICATION AN I OMPLY WITH THE STATE <br /> PARCELTA%I.D.NUMBER CONTRACTO AN 296200WAC..�f'� <br /> � l T <br /> CONSTPUCTION IORN LENDER,pDOPESS.TELEPMONE NUMBER x <br /> SIGNRTURE D�TE <br /> �, CITV BUSINE55 LICENSE N0. <br /> `� PLUMBINQ MECHANICAL <br /> , � NO. TYPE OF flXTURE OH ITEM FEE NO. TYPE OF flXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. � <br /> BATHT�-.: ; FORCEDAIRSYSTEMS—B.T,U �M E.A. ; <br /> LAVATORV(WASH BASIN� � HEAT PUMP , <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS ' <br /> i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD ; <br /> CLOTfiES WASHER � WATF.R HEATER � <br /> URINAL WOOD STOVE � <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) ; <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE � <br /> GAS PIPING � <br /> � EXHAUSTFAN � <br /> � � <br /> � � <br /> SUBTOTAL $ ; SUBTOTAL $ ; <br /> PERMIT S � PERMIT $ i <br /> TOTAL FEE $ � TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBpCK REARSETflACK SIDESETBRCK PLANCHECKNUMOE FEE RECEIPiNO. <br /> 3 <br /> usezoNe toinnen VqCANT517E FEES VALUATION FEE <br /> rnes n No ouuowc I <br /> i <br /> HEIGHTLIMITRTION NOOFOWELLING SIZEOFULOGrti. <br /> UNITS <br /> P W MOiNG � <br /> � <br /> OCCIIPRNCV NOOiStORIES OCCUPANTLOPD BASEMENT <br /> GROUP M[d1nNIGnL I <br /> ❑YES [l NO <br /> � <br /> FlREALARMRE(1'U qEqSON ADDIPONALPLANCNECK � <br /> i <br /> OTNER i <br /> FIRE SPRINKLER REO'D REASON <br /> i <br /> � <br /> STFTE BUIL�ING SURCNARf,E � <br /> TVPEOFCONST Pl/NSAPPROVEDBV CITYOFEVERETT PU�LICWORNS � <br /> LOCALSALES <br /> DATE TAX CODE�S 3105 TOiAL ; <br />