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�} <br />� � � ���� <br /> ;. <br /> APPLICI�►T12,N FOR COI�STRIlC1 i0 ���{� �>': ` <br /> CITY OF EVERETT• BUILDING DIVISION '� 8 ]9 <br /> 3200 CEDAR STREET• EVEHETT, WA 98?.01 •259-881U"""" -_.. �-�" <br /> CITY pF���ERET <br /> .... <br /> fl DEMOLITION f 1 COMBINATION f� BUILDING I MECH NICAL P�hli!LfJy�IP T f l SIGN <br /> PROJECT ADDRESS �. � ' <br /> OIVNEq MFILApG^PSc /_��� � z � PHONF n <br /> ` � K <br /> TENr1NT MpILA�DRF.55 fllY 71P ��O4F <br /> �2�' -�7,7� <br /> ARGHITFCTOROESIGNFR 1,1pILpDOPE55 CITY ZIP PNONE <br /> GENEfINCONiRqCTOH MAILqD��ESS Cllv ZIP PI10Y[ $TqiELICENSE� <br /> MECHANICALCONTR�GTOR MAILADORE55 CI7V LC PIIOPIF ST4TF.LICF.NSEi <br /> �.rUCP�z�,i��1��Qlir���1��I_� �tl� �f��"� �.��9 `�� <br /> PWMBINGCOKIRAf,TOR MAIL�D�PES ��iy T Z�P ����f I �i������ <br /> CUNTBACT PRICE OF WOfiK <br /> _ HEATING SYSTEM: D( GAS f-1 ELECTRIC f 1_ <br /> OESCRIDE YJGRK AN�SO:IAdE FOOl�[.E INVOLVEJ CO TACT PERSON pND P �NF NO <br /> , . � .� �. <br /> ° ' i�-Jo-��7��'2 I � <br /> I HEREBY CERTIFY TI1AT I HAVE FEAD A�D EXAMINED THIS <br /> PaoaO�p u5G OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT qLL <br /> G i2 PROVISIONS OF LAWS F,ND ORDINANCES GOVERNING THIS TYPE OF <br /> —`L � � 'NORK WILL BE COMPLIED WITH WHETHER SNECIFIED HEREIti OR <br /> LEGAL DESGRIPTION OF PROPERTY(SNOWN BP.LOW O TTACH 7VJ0 UOPIES� <br /> i NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or�_BLOCN oF _ ' �� AUTHORITY TO VIOL�TE OR CANCEL THE PRGVISION OF .4NY <br /> O�HER S7ATE OR LOCAL LAW REGUL�.fWG CONSTRUCTION OR THE <br /> _ PERFORMANCE OF CONS fRUCTION.THAT I P.M AUTHORI"LED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PPPLICAI�ION IS MADE AND I COMPLY WITH THE STATE <br /> PAflCELTA%I.D.NUM9ER CONTRACT�RS LAW 18.27 RCW AND 296.200 WAC. <br /> . CONSTPfICT10NLOPNLENOER,qODRE$S.TELEPHONENLMOEq � ,inO A�� ) �! O'.ZI�/ <br /> � 51 ATU / �IOJ K� <br /> -�-��9 3 �,F <br /> i. diY BUSIhESS LICFNSE FIO <br /> � PLUMBING MECHANICAL <br /> � ' NO. TYPE OF FIl(TURE OR ITEM FEE NO. TYPE OF EQUIPMENT PEE <br /> . _ WATERCLOSET(TOILET) q/C—A/HNDLGUNITS—H.P. �— <br /> � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.0 E.A. ' <br /> LAVATORV(WASH BASIN) � HEAT PUMP —;— <br /> SkiOWER � UNITHEATERS—B.T.U. M <br /> KITCHEN SINK& DISP ; CLOTHES DRYERS ; <br /> DISHWASHER VEhTILATION FAN � <br /> LAUNDRY TRAY � RANGE HOOD � <br /> CLOTHFS WASHER WATER HEATER <br /> URINAL � WOOD STOVE <br /> DRINKING FOUMTAi�,� METAL FIREPLACE(WOOD BURNING) i I <br /> FLOOR DRAIN � FIREPL.4CE INSEPT(WOOD BURNING) �- I <br /> _ BACKFLOW PREVENTERS ; GAS FIREPLACE ' � <br /> _ SINK(SERVICE—BAR, E7C.) � I GAS RANGE , <br /> ; GAS PIPING � <br /> � EXHAUST FAN ; <br /> ' � I <br /> � � <br /> SUB TOTAL S ; SUB TOTAL 5 ' I <br /> PERMIT § i PERMIT 5 <br /> TOTAL FEE S � TOTAL FEE $ <br /> FOR OFFICE US@ ONLY: <br /> fRONiSFTPnCK REARSFiB�CK 51DESET64CN PtANCIIECNNUMl3[R ffG R[CfIPTNO. <br /> usezone tornaea vncnnrsire FEES VALUATION FEE <br /> _ IIYES fl NO �pIL�WG � <br /> � <br /> LIMIiATION NOOFUWELLING SQEOFpL�G/11 - - <br /> i <br /> lIN1T5 <br /> PLUNf1WG <br /> OCCUPANCV NO O�SIOPiES OCCUPANILOAD BASEMENi � <br /> GROUG MECIIqNIf.AL � � <br /> � <br /> IIYES II NO � <br /> FIREALAFMREO'� BFASON 4DDIIIONPLPIANGeF.CN <br /> Oi11ER <br /> FIfiF.SPRINKI.ERREO'0 RE4$pN <br /> i <br /> Si4iE OUILDING 511liCHApGE � <br /> Traeorr,oNsr vinvsnrvno•ienor CITYOFEVERETT runur.wones —T <br /> LOCALSALES — <br /> �qTE TAX CODE IS 3105 TOTAL � <br /> — --- -- ----- -- -�-- I <br /> _ _. _ ._ --�- ---.. ._ . <br /> � � .. — . .. ..-- . . � � '��' . <br />