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APPLICATI�i�I FOR CONSTRUC�N PERN!!T <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> fl DEMOUTION fl CQMBINATION I� BUILDING f�MECHANICAL �1 PWMBING �l SIGN <br /> PROJECT ADDRESS / � <br /> I7� - `�1� iZ��-�'-�9� <br /> .� - . n<<. � <br /> OWNER M�IL�DORE55 1 CI(rV �� /{P PMONE �/' <br /> �/yN� GOA)5'k��n�A� ����c� �9 ���l� //�h l Ii�'-r%� .�J� -(/%�� <br /> TEN�NT MqL�DORE55 Cltt IiP PNONE <br /> �RCHITf.CT OR OESIGNER MAII.�ODRE55 CITY 71P pHONF <br /> Q��Ji L'ONSi�t,�C70,� <br /> GENER�ICONTpl1CTOq MAILADORE55 GIl'I )iP PiIONf: SIAfCLICCNSE• <br /> �cJ2i7'� FiRE PkoTEC77o�J i2e� 8�.6J�e WN aP �E a�r�✓� c�A 98��04- <br /> MECHANILALCONTRRCTOR MMIADDRE55 CITV ZIP PIIONE STATELICENGE� <br /> (o9fo-92�'� 5ec�l�2FPo5085 <br /> PLUMBINCsCONTRICTOR M�LL�pDRESS CIIY 21P PNONE STATEIICENSE� <br /> '�(0800 <br /> CONTMCT PRICE OF YrIX1K <br /> HEATING SYSTEM: f l GAS �l ELECTRIC fl <br /> DESCPIBE WORK�NU Wl1ARE FOOTAGE INVOLVED CON7�CT PF.FSON RNp PHONE NO <br /> ,�s ,� <br /> P� n/FPA l32 - <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> vnoroseo u5E ov eu�wrro APPIICATION AND KNOW THE SAME TO BE TpUE AND CORRECT 4lL <br /> Cp�J jap�t PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN O�i <br /> LEOALDESCPoPTIONOFPIqPERTV(SMOWNBELOWORATT�GHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 70 GIVE <br /> �or e�ocK or AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORRED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE D I COMPLY WITH THE STATE <br /> PNICEL TN(I.D.MIMBER CONTRA TORS 1 W AND 296.200 WAC. <br /> � / <br /> CONS7NUCTION IOAN LENOER.�DDPE55.TELEPNONE NUMgEp x '�I S <br /> SIGN�T O�TE <br /> dTY B NE55 LICENS[N0. <br /> PLUMSINO MECMANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TVPE OF ECUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—lVHNDLGUNITS—H.P. � <br /> BATHTUB ; FORCED AIR SVSTEMS—B.T.U. M E.A. ; <br /> LAVATORV(WASH P �tN) � HEAT PUMP , <br /> SMOWER � UNIT HEATERS—B.T.U. M <br /> KITCMEN SINK 6 DISP ; CLOTHES DRVERS ; <br /> DISHWASHER VENTILATION FAN � <br /> UUNDRY THAV ; RANGE HO00 ' <br /> CIOTHES WASHER � WATER HEATER � <br /> URINAL � WOOD STOVE � <br /> DRINKIN6 FOUNTAIN METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIHEPLACE INSERT(WOOD BURNING) � <br /> / BACKROW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE <br /> p/'L $f�/nlKlf.� GAS PIPIN6 <br /> � EXHAUSTFAN , <br /> � ' <br /> SUB TOTAL S SUB TOTAL E � <br /> PERMIT S PERMIT $ <br /> TOTALFEE S � TOTALFEE S � <br /> FOR OFFICE USE ONLY: <br /> FPONT SETPAGK pF�R SFTB�CN S�DE SETARCk PIRN CII[Clt NUMAER fEf PECFIPT NO <br /> �� �I �� <br /> J <br /> USE20NE iar�nen VACRNt511F FEES VALUATION FEE <br /> fIYES ItNO �UIIDIN(i � <br /> �_ <br /> HEIGIR LIMITIITION NO OF pWELLING SIIE O�BlOG41 — i <br /> UNITS <br /> PL�IMOING <br /> GC�CO^ANCY NOOfSt�RiES OCCUP�NTtOAO B�SEMENi M[CII�NiC�L _--�� <br /> i <br /> IIVES fl NO - <br /> fIREAURNREOD RF450N PpDI110NRLPIANGIfCN <br /> i � <br /> on�en !' n� n� /lJ I r��_ <br /> FlRF.SPRINNIERRf:O'D RER50N I - <br /> SiN[OU�IDIY:511RCIInfif.[ <br /> TYPEOFf.ON57 PIANSRPI'ROVFDAV CITYOFEVERETT runur,wonKs � <br /> � LOCAL SALES - —�-;— <br /> uaE , f2� l TAX CODE IS 3105 TOTAL Q'� � " , I ; <br />