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APPLICATIOnI FOR CON�TRUCT�ON PERNIIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> f 1 DEMOUTION f 1 COMBINATION f I BUILDING f l MECHANICAL �1 pLUMBING ! '.✓SIGN <br /> PROJECT ADDRESS <br /> !�:�o ct(� �S� S� <br /> OWNcR MnILA0DRE55 Cltt IIP PHpN[ <br /> Co✓,��i,��-rc�LE Prosr�-tc-ii�S �3c o ��y�'��T ,' � i Qy �� <br /> iENqNT MAILqDpRc55 CITY LP PIIONE <br /> ARCHITfGTORpESIGNEP IAAILAOORE55 Qtt ]IP PNONE <br /> 1%'lYi�2Srt14LL Sl6�vS 21IZ C-rq�¢, �'� �k.,'C �g�J) Z-S� bg6� <br /> GCNERALCONTftAC70R MAILADORE55 CiIY ZIP PNONG SiATF.IJCENSE� <br /> _�diU.Fe�<�c.�s� r�.,�, _ 3s � c�Av_5 AvE C c-�Tr- u ✓�9v�ul �z 3�� Wv�F�r_zob( K�y� <br /> M6CHANICALCONTR�CTOR MnllAo�RE55 CITV ZIP PIIONE SintF�IC[NSE� <br /> PLUMBING CONTRACTOR MAILAOORE55 CI7� ZIP PNONE STATE I.ICENSE• <br /> WNTRPGTPRICEOFV/OR � <br /> Z�-�� HEATING SYSTEM: f 1 GAS f l ELECTRIC fl <br /> DESCRIBE WORK AND$OIIARE FpOTnGE INVOLVED CONTAC�pt��I�p iONE NO <br /> J1P,\��U ���.�-=�3-17 � <br /> S'v'^ ����� riAtzsrW��S�E�.S z��-�Kd l <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUIIDING APPLICATION AND KNOW THE SAMF TO BE TRl iE AND COPREC7 ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GUVEqNING THIS TYPE OF <br /> LEGALOESCFIPTIONOFPROf'ERTY�SHOWNOE�OWORATTAGHTWOCOPIES) w'ORK WILL BE COMPLIED WITH WHE7HER SPECIFIED HEFEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT 9LOCK oF AUTHOFlITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> (�THER STATE OR LOCA�LAW REGULATING CONSTRUCTION OR THE <br /> PERFnRMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER Of THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS b'ADE AND I COMPLV WITH THE STATE <br /> PARCEL TA%I D.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> GONSTRUCTIONIOANLENOER.A0pqE55.TELEPHONENUMBEP . �s.(�� IO�S �l l <br /> 51 NFTURE /� <br /> f/ D4iF <br /> CIiY pU51N.E55 IICBNS'_NO. <br /> ' PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) q/C—A/HND;.G UNITS—H.P. � <br /> �_ <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVAfORY(WRSH BASIN) � HEAT PUMP — ,T— <br /> SHOWER � UNITHEATERS—R.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS ; <br /> DISHWASHER VENTILATION FAN i <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER WATER HEATER , <br /> URINAL WOOD STOVE <br /> DRINKING FOUNTAIN i METAL FIREPLACE(W70D BUPNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(W70D BURNING) � <br /> BACKFLOW PREVENTERS ; GASFIREPLACE ' <br /> SINK (SERVICE—BAR,ETC.) GAS RANGE � <br /> � G�S PIPING � <br /> i EXHAUSTrAN � <br /> i � <br /> � <br /> � <br /> SUB TOTAL S S�,JB TOTAL 5 � <br /> PERMIT 5 i PERMIT S i <br /> TOTAL FEE 5 � TOiAL FEE 5 ' <br /> FOR OFFICE USE ONLY: <br /> fRONT SFTPFCK, REAfi$FTpAGN SIOE SETBM1CK P�AN CIIECK N AlfifR F[F RFCEIP7 N0. <br /> o � ` �� ' 7/ 334� <br /> � <br /> useioNe �AAen � vnr,arurcire FEES VALUATfON FEE <br /> I —Z Z I NVE$ I t NO —T_ <br /> -- aunoir�c � -- <br /> MEIGlIT LIMITAiIOh NO OP pWELLING 512E Of BIDGRI <br /> � / UNIi$ <br /> PLUIJEiING <br /> OCCUPANCY NO Of510RiE5 OCCUPANTLOAO BnSEMENi I <br /> GROUP MEQI�NICAL <br /> i <br /> IIYES I1 NO — <br /> FlREALA(lA1RE0'D RFASOY ��UIIIONnLPI.nNCHfCK <br /> onien <br /> FlRF SPPINKI.F.R PFOD RF�SON <br /> $t.tl[011lf�MG SURLN�RGE � "� <br /> �_/ <br /> rvaForr.ovsT ci.nNsnnvnovEnnv CITYOFEVERETT ruptiCwonKs � <br /> J/" LOCAL SALES --'-- <br /> onrE 1L��3 /l TAX CODE IS 3105 70TAL � <br /> --- � -----_..— —` — <br /> �,,—�."'_�� , "':bYb ''r.. �';�`s <br />