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�� r�a <br />APIPLICATIL.� FOR CONSTRUC7.ON PEI�MiT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOUTION Cl COMBINATION f�BUILDING f.�MECHANICAL �PLUMBING fl SIGN <br />PROJECT ADDAESS - <br />ST <br />OWNER IAAIL <br />30HIJ UR Bani <br />�VE��TT <br />CI*Y ZIP <br />mnnrvi MAII.MDPE55 CIiV ZIF �U I7� _'S 7� 9 <br />PMONE <br />ARCNITECTORCE3IGNER MAILAD�RE55 ��ry ��� <br />PHONE <br />_��%1 �i-/LES _ �AJA//niNiC� <br />3ENERAL <br />PLUMBING CONTG <br />ma��.�w�reb� Cliv <br />P-r7• BoX 666� i � <br />MAILADDPESS <br />MAIL AOOPESS <br />GONTRACTPRICE O� WORK <br />/ ��, O� � <br />DESCRIBE WORKAND SOUAHE FOO7AGE INVOWEO <br />BELOW Gfl <br />ior 2 2 s�ocK <br />�� <br />PARCELTA%I.D.NUMBER <br />A/3s- Doo -072 - Doo y <br />CONSTi7UCTIONL9AN LENUER,AD�RESS.TiLEPHONE NUMBEP <br />WATER CLOSET <br />BATHTUB <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOYJPREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TO <br />i'ERMIT <br />TOTALf <br />FOR OFFICE USE ONLY: <br />FRONT E ICY, FA6 SET <br />�� � <br />JSE Z� � I UTARE/ <br />✓ <br />I NO nF pWELLING <br />� UNI7 � <br />� <br />l;� <br />lER REO'D <br />d <br />�'N / I DATE S' � <br />� <br />"' PIICNE STATE LICENSE n <br />� �S�'�'6 ��EST EHOSSSF <br />Zlv PHpNE STATE LICENSE / <br />Z�P PHONE STATE LICENSE <br />HEtiTING SYSTEM: Gil GAS ❑ ELECTqIC ❑ <br />CONTACi PERSON AND PI10NE t�U. <br />7nNW VA/SI?ni ��i_c-� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAN'S AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GI4E <br />AUThORI7Y TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHEF STATE OR LOCAL LAW REGULqTING CONSTRUCTION OR THE <br />P[RFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHOFIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION I; MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />SIGNATUR '� — C/ •/�_ <br />DATE <br />CITV BUSINESS LICENSE N0. <br />FEE NO. TYPE OF FIXTURE OR ITEM FEE <br />' A/C—q/HNDLGUNITS--H.P. <br />� FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br />� HEAT PUMP <br />' UNIT HEATERS — B.T.U. M , — <br />1TI0�' FAN <br />HOOD <br />WOODSTOVF <br />NETAL FIREPI <br />FIREPLACE IN <br />GAS FIREPLAf <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />$ <br />S <br />s <br />�utStl�nGK / P�ANCf1ECNNU R <br />�• �` </�%�11F <br />VACRNT SITE FEES <br />f7VE5 fl NO <br />�UILOING <br />IF OLOGR I <br />yQ SF �Iviti4 { PLUMpING <br />y SF GA.QAGE <br />BASEMENT <br />MECMANICAL <br />I]YES � <br />FUDIT�ONA� PLAN CHECK <br />OTNER ��j� � <br />U <br />STATE BWI�ING SURCN�RGE <br />CITY OF EVERETT PUBLIC WOfiKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE S <br />FEE RECEIPT NO. <br />��� 7� � i L� � <br />