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APPLICATI�.A FOR CONSTRUC7 .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION �C� <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> fl DEMOLITION fl COMBINATION f� BUILDING f� MECHANICAL �!�PLUMBING fl SIGN <br /> PROJECT AD'DRESS <br /> �l`l0 I�rrpfe- !'r. <br /> OMMER MSIL�DDRE55 CITY zm pHON[ <br /> Qyjlni �ah�T ;�✓i • IllZ2 99� ��c +�z A,a.�ixro� ���3 331-0�'3f <br /> TEN�N! MML�DORESS GlY ]IP C P��ONE <br /> �aCNITECTOR0E51GNER MRII�DORE55 CITY )Ir pHONF <br /> GENER�ICONiR�GTpi MAILPDDRE55 C�Iv iiP pH04[ SiATCIICFNSE� <br /> �1e.en�+�os5Ki3 <br /> MECHANICRICONTRnCTOR MAILRDDRE55 f.ITY 714' PPpN[ STnTEUCGNSE• <br /> n�, �,.�. Pl✓mb��i�nr��w-m.^s �.✓c- i�I09 3� Au�.Ja� h�p��/�� 9�'a�/ 6s��G�39 <br /> PLUMBINGCONTR�CTOR '� MMLApDRESS Llrv ZIP � p110NE SiAiELICF.NSE• <br /> CONTP�CT PRICE O(WORN <br /> HEATING SYSTEM: I i GAS �l ELECTRIC �l__ <br /> DESCRIBE WORK�ND SOU�RE FOOT�GE MVOLVED LONTA(;T PFNSON/ND PNONf NO <br /> .CC J�/, <br /> I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> P{IOPOSEO USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND OPDINANCES GOVERNING THIS TVPE OF <br /> WORK WI�L BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCR�PTIONOFPROPERtt�SHOWNBELOWORFif�CNTWOCOPIES� NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> tor e�ocK oF AUTHORITY TO VIOLATE OR CANCEL 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 /> APPIICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL iAlf I.D.NUMBER CONTRACTORS LAW 18.27 R AND 2962U0 WAC. <br /> CONSTRVCTION LOAN LENDER.���RE55.TEIEPNONE NUMBER X IY�L;-���_��Z �/ � <br /> SIG TURE O�TE <br /> dTY BUSME55lICENSE NO <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. 7YPE OP EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNRS—H.P. <br /> BATHTUB � FORCED AIR SVSTEMS—B.T.U. M E.A. � <br /> y IAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAV � RANGE HOOD � <br /> CLOTHES WASHER i WATER HEATER <br /> URINAL � WOOD STOVE <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BUFNING) <br /> BACKFLOW PREVENTERS � GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE <br /> GAS PIPING <br /> E%HAUSTFAN � <br /> i <br /> i <br /> SUE TOTAL $ SUB TOTAL $ � <br /> PERMIT 5 i PERMIT $ .i � <br /> TOTAL FEE $ ,, � TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> �RONTSFTPACN REAp5FT0l1CK SIDESETflACK PIGHf,PfCKN FR fEE �Ff,fIPTNO <br /> � <br /> usezor+e ioranEn vncnr��sre FEES VALUATIOM FEE <br /> _� <br /> i�rc-s i; rvo omirnNc � <br /> I <br /> IIEIGNT IIMIt�T10N NO OF UWELLING 512E Of BLDGR I <br /> UNIf$ <br /> PIIIMOMG <br /> � <br /> OCCUPANCY NO M S10FiE2 OCCUPRNTl04U BASEMEYT � <br /> Gf10UP MFCIIANIC4l � <br /> f1Y[5 I+ NU � <br /> FIRE�UPM REOD RfI50N AOUI1104AI.PI�N CNf f,N � <br /> i <br /> _ OiH[R <br /> IIRF.SPPINNIEHRFOO RFASON <br /> SiAi[OUIIDING SIIRGIII.RGf <br /> i <br /> trrForr.or+sr r�.nHs•rvnaveoer CITYOFEVERETT rimiir,wonns <br /> LOCAI SALES - — - -----�'— <br /> up,t TAX CODE IS 3105 7oiA� I <br />