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- .-. <br />AP�'LICATIOr! FOR CQI�STRUCT�ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />f] DEMOLITION COMBINATION fl BUILDING I-1 MECHANICAL rl PLUMBING f-I SIGN <br />PROJECT ADDRESS � "� <br />cJ�7� V � . � Svv <br />OWNER MAIL RODRE55 f�� Cltt �` IIIP 1 �MONE 3`11 b- o;,�^ to ( <br />�n��� I Ii�1lnC� � �.1,. I V I' ) ��\� ��V �{"�1PIl ��V�..� <br />TENANT MAILR�ORE55 CItY IIP --r PHONE <br />ARCHITECT OR DESIGNER MPIL qDORE55 �ITY )IP PHONE <br />GENERRLCONTRACTOR MAILA�OBESS CItV ZIP PIION[ "7'�-C,Z(vI5LA7ElIC[NSE� <br />(Vl �,c c� o mn n LL t? �i5�1 t'3 Rr,l2, n Ci �- � uii- l�,y� �. �o � � 0 C� gn I a m E-r• eoe-z ysk� <br />MECH�NICAICONTRACTOR MAILAODRE55 CITY ZIP T— pHONE STATELICENSE� <br />PLUMBINGCONTRACTOR MAILADORE55 pI�Y 21P PHONF STATEUCENSE� <br />SCRIBE WORN AND SOUAHE F01 <br />n n ��-C uc_�- � <br />�11b��� Quc� <br />-i.o l\;� <br />PROPOScEU USE OF Btll DINGr� <br />l�li YIC. 0 K! <br />LEGALDESCRIPTI PROPERT <br />wr �_ e�ock _ <br />Q1a� c��`� <br />Pha�o �I .. <br />PARCEL TiV( I.D. NUMBER <br />INVOLVED <br />�..,. tt <br />CONSTRUCTION LOFN LENOER. ADOPE55. TEIEPNONE NUMBEH <br />PLUMBING <br />HEATING SYSTEM: �GAS I-1 ELECTRIC fl <br />LONTnCT PERuOK �.NO PHONF NO <br />�'1�i��n.,... WY1 Cnrnr,i `i\1..—/�1i <br />�I �_ I HEREBY CeRTIFY THAT I 11AVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />� ol � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />e- WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />5j NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL tAW REC.7LATING CONSTRUCTION OR THE <br />� PERFORMANCE OF CONS'fRUCT10N. THAT I AM AUTNORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WO��K FOR WHICH <br />APPIICATION IS MAOE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />x��{1��r1 �,CC[,� 1-110-9s <br />51�,���/��ati�K DFTE <br />CITV BUSINE55 LICENSE NO. <br />MECHANICAL <br />TVPE OF FlIITURE OH ITEM � FEE <br />WATER CLOSET ITOILETI <br />LAVATORY (WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW FIIEVENTE <br />SINK (SERVI(:E �— BAR, <br />i <br />1 <br />I <br />1 <br />SUB TOTAL $ � <br />PERMIT $ � <br />TOTALFEE $ ! <br />FOR OFFICE USE ONLY: <br />FRONT SEiPRCN � REAR SETBAC i <br />USE 20NE. LOT nREA , � <br />—�' � <br />HEIGHT LIMITATI� <br />G� <br />OCCUPANCY NO 0{ <br />GROUP <br />FIRE AUPM RE00 <br />FIRF $PRINNIER HF.1 <br />I NO OF DWELLING <br />� ONITS <br />RE�iON <br />EOUIPMENT I FEE <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WOOD STOVE ; <br />METAL FIREPLACE (WOOD BUF;NING) � <br />—r— <br />FIREPLACE INSERT (WOOD BURNING) � <br />GAS FIREPLACE ; <br />GAS PIPING <br />EXHAUSTfAN <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />PIANr�1ECNNUMF1fR �FEF IRF.CEIPiNO. <br />VACANT SITE <br />IIYES f i NO ypIIOWG <br />)F BLOGR I <br />31 ff Li�;iN,y} p�pM91NG <br />ES I I NO <br />MECN�NICAL <br />RDpI110NA� p�AN G��ECN <br />Oi11ER <br />STNE OUILDMG SURCII�RGE <br />PinNsnrrnpv�pv CITYOFEVERETT ruAi.ir,wonKs <br />�1 LOCAL SALES <br />os�� i/� Z/ai. TAX CODE IS 3105 TOTAL <br />7 <br />