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APPLICATI� FOR CONSTRUC�N PERMIT <br /> CITY OF EVERETT• BU!LDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98207 •259-8810 <br /> f� DEMOUTION (l COMBINATION fl BUILDING fl MECHANICAL i l pLUM81NG �1 SIGN <br /> PROJECT ADDRESS <br /> /�22/� S/�l/c�'.E' -��.�� �-4.G <br /> OMMER M�RAOC.lE55 CITV Zip <br /> PIION[ <br /> _C'iry oF �--��.e��T .3/Oi ����� . ,-r1 �.� � <br /> TENIINT MMLR1DpPF55 fITY ZIP PMO4E �—TTl <br /> �//� � ��+}� � � <br /> �ACMITECTORpE51GN[R qI�DO 55 CIIV ]�P PNOM1F <br /> GENEf1�LCpNiMLTd1 MAILADUP[SS CILY PiP PIION[ SiqT@LIC[NSE� <br /> MECH�NICRLCONIR��TOR MAILADpRF.55 Clry 71� <br /> PHONE ST4TE LILGNSE i <br /> � .rr�.rid � � �zlBs�-v,P! E'�-,�-�r ��ap�i-r.�i.s��8io�- <br /> UMBINGCON7Rnf,i MnIL�1�RE5S <br /> f,IiY IIP PNONE �—T <br /> S1ATE IICENSE• <br /> CONTRAGT Pq�CE OF V,ORK <br /> Sd � HEATING SYSTEM: ,f�GAS !-1 ELECTRIC fl_ <br /> �ESCRIBE VppK ANO SOU�RE FOpTAGE INVOLVEU CONiACT PFRSONANO PNONF NO <br /> C 7 � � <br /> I HcREBV CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSEDUSEOFBl11LDING APPLICATION AND KNOW THE SAME TO DE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LECALDESCRIPTIONOFPROPERTY�SHOWNBELOWOPRTUCNTWOCOPIES) WORK WILI BE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br /> �oT BIOCK or A�THORETYTOTVIOLA EAOR CANCELET E�PROVS�ION OF A'NY <br /> OTHER STATE 0{i LOCAL LAIV REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOR12ED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> GARCEL TN(I U.NIIMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSIRVCTON LO�N LENDER,ADpqE55.TEIEPHONE NUMpEH �l��/__- 7� �� <br /> SIGN�TURE �'� <br /> �TE <br /> Cltt BUSINE55 LICFNSB NO ' <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF flI(TUIiE OR ITEM FEE NO. 7YPE OF EOUIPMENT FEE <br /> � WATERCLOSET(TOILEn � A/C—ARiNDLGUNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U( M E.A. � <br /> LAVATORY(WASH BASIN) HEAT PUMP � <br /> SHOWEfl � UNIT HEATERS—B.T.U. M i <br /> KITCHEN SINK 8 DISP CLOTHES DRYERS <br /> DISHWASHER VENTILATION FAN � <br /> LAUNDRV TRAY RANGE HOOD � <br /> CLOTHES WASHER WATER HEATER —r— <br /> URINAL WOOD STOVE i <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) ' <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BUPNING) i <br /> BACKFLONJ PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR, ETC.) � GAS RANc;E , <br /> GAS PIPING � <br /> � � EXHAUSTFAN � <br /> i '--�— <br /> � <br /> i <br /> SUB TOTAL $ ' SUB TOTAL $ , i( � <br /> �«_� <br /> PERMIT $ � PERMIT 5 i <br /> T0T4L FEE $ � TOTAL FEE $ / � .— <br /> FOR OFFICE USE ONLY: <br /> fRONT SETPRCK RFAR cFTBACK SIDE SEiBACR P14N CIIECN NJMp[fi �FF PEf.HPT NO <br /> usezoNe iorna¢n vncnntsite FEES VALUATION FEE <br /> _ i i res i�� r+o nunoiNc � <br /> NEICIIT LIM�IRTION NO OF OWELUNG Si2E Of BlUG41 � � <br /> UNIiC i <br /> riun�nwc <br /> OCCUP:NCV NO 0t SIORi[5 OCCUPANT 104p PASEMEN� —}— <br /> OROUP MfCI1�NiLRt <br /> I 1 vE5 �i NO <br /> i <br /> FlRE�LARNREOD f�f450N ADUIIIONM.PIANCIIf.f.K i <br /> �f— <br /> O1H[R j <br /> fIRFSPRINKIERREOD RFnSpY <br /> STn1E O111l�INC SURLH4qGE i <br /> Troeorr,or+sr rinNsarvnovenor GTI�OFEVERETT runnr,wancs —~ <br /> LOCAL SALES -- -- — <br /> on,e TAR CODE IS 3105 707AL <br />