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APPLICATIG.�1 FOR CONSTRUC7 .JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> R ', • <br /> 3200 CEDA S �IEET EVERETT,WA 98201 •259•BB10 � <br /> fl DEMOLITION fl COMBINATION I l BUILDING f- MECHANICAL t� pLUMBING f 1 SIGN <br /> PROJECT ADDRESS <br /> �T = _ ' � <br /> �R M��L�OdiE55 cin zir rHor+t <br /> 1cNna� �Auu�az �3�ti �vc�� AvF Cve� ,-� GBao� (arc.� ��R-�3o�� . <br /> TEN�NT MMLApDRE55 f,ITV Jlo pNONE <br /> `�AMe <br /> 1RCNITECT OR DESIGNER MMl ADORE55 Lliv )iP PIIONF. <br /> GENE{iMCONTPaGidi MqL�DORE55 CIiV IiP PIION[ SLRTEUCENSE� I <br /> �E \\ <br /> MECHANILRLC09TRACTOR MMIPDOPE55 Cltt DP PIIONE STAtEUCENSE� <br /> PLUMBINGCON7R�CTOR MAILAUDRESS CItY ZIP PHONE STAIEUCENSE� <br /> CONiR�CTPRICEOf� ` � HEATING SYSTEM: I GAS fl ELECTRIC I-l_ <br /> OESCRIBE,YO�J(;ND SOU^RE FOOT�GE INVOlVEO CONTRCT PEBSON AND{'NONE NO <br /> ���� � <br /> 1 - <br /> 1 HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUILpNO APPIICATION AND KNOW THE SAME TO BE THUE AND CORRECT PLL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF � <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALOESCRIPTIONOFPROPER7Y�SMOWNBELOWORATTRCMTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PHESUME TO GIVE <br /> �oT� eiocK oF AUTHORITY TO VIOLATE OR C.4NCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPIICATI N IS MADE AND I COMPLV WITH TNE STATE <br /> PMCELTA%ID.NUMBER CONTRA�RS LAW 1827 CW AND 296200 WAC. <br /> � ��///� ( <br /> CONSiRIICTONLO�NLENDER.A00RE55.TELEPMONENUA�BER x��� �VA_ // %l� � a e _ � � <br /> SIGNIITURE OAfE <br /> CITY BUSINE55 LICENSE N0. <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FlI(TURE OR ITEM FEE NO. TVPE OF EQUIPMENT FEE <br /> —�— <br /> � WATERCLOSET(TOILET) � A/C—A/HNDLGUNRS—H.P. �_ . <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRVERS i <br /> DISHWASHER � VENTILAT�ON FAN <br /> UUNDRY TRAY � FANGE HOOD i <br /> CIOTHES WASHER WATER HEATER <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLAGE(WO00 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 � <br /> i ' <br /> SUB TOTAL $ SUB TOTAI $ <br /> PERMIT S PERMIT F i <br /> TOTALFEE 8 ' TOTALFEE S '' ' <br /> FOR OFFICF USE ONLY: <br /> {'RONT SFTPACK AF.AO$F.TBACN SIDE SETBRCN Pl4N CII-C N MA P f[C- RfCFlPI NO <br /> usezor+e �.orenen vne�rursire F ES VALUATION FEE <br /> T <br /> IIVF.S ti NO i <br /> owinwc , <br /> NEIGIIi LIMIfATION NO Of UWF.LLING 5�2E Of BlDG41 <br /> IINItS PLIIMOMG � <br /> � <br /> OCCt/P�NCY NO Of S10RR5 OCCUPAM I.OAO 9ASEA�EN1 MfCH�NiCM. � <br /> Gnouv <br /> II1E5 I1 NO � <br /> FIREAURAIPEOD fiGRSON Af1D�1104N.PLANCNf.CK i <br /> --'i— <br /> O1N[R <br /> i <br /> fIRF.S�PINqERRF.nII RFAFON � <br /> 51�1[IlUI1DMG SURCH�f1GE <br /> rvre or r,or+sr ri nus nrrnovFn m CITY OF EVERETT runi ic wonKs <br /> LOCAL SALES <br /> ��p�E TAX CODE IS 3105 iOTAL _ � <br />