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APIPLICAT14�1 FOR CQNSTRtJ�C? r4Q+1 PE�MIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETf, WA 93201 • 259-8810 <br />f� DEMOUTION � COMBINATION I-1 BUILDING I-1 MECHANICAL rl PLUMBING f l SIGN <br />PROJECT ADDRESS <br />I �� I �lr <br />`��,rF' �� C�LA�, � C�C� 1'-E� � <br />RDDRESS C�fV ZIP <br />� ^ '� 1 11 � <br />- p7- <br />1i lE'\-C c� I��r(1C � � L i� � /,`�I -, , ,('�%^' - t��-� � � � �-�u_� � ,.,•_., - <br />TENANT MAILR�URES"s Clif ZIP F110NE <br />ANCHITECTOHOESIGNER MPIIA�pRE55 GI!Y 7.IP PNONE <br />GENERALGONTRAGTOR MAILADURESS CIIY 21P PUJN[ 3��;-(�Z,��STATELICENSE� � <br />44,r-__1 �QOI�mE��'-r,ez�3K� <br />JYl.,1-�,. 11...��r�c 1\(� luq��, I'v����\ �i'Dnf�� �-���,v �X'� � <br />MECHANICALCONTRACiOR MAILADORE55 GN ZIP ' PHONE STT1ELiGtrvJe• <br />PWMBINGCONTRACTOR MAIIADORESS CIN 21P PHONE STATELICENSF.� <br />CONTR�CT GRICE OF WOftK <br />D RIBE WORK ANO SOUARg{ T�GE INVOLVED <br />�Cl(l���Tl 1 C i' 1��(lfl # I 1 <br />��i�inr�_ � r-vP� �lc�,(l�P <br />r�r, '-I �.1 ?, R`� �n � n(� i <br />L07- �� � 6LOCK � <br />.�� �� '-rr� oi � <br />v_ <br />�hc•, �' � 1- - <br />PMCELTA%I.D. NUMBER <br />���_�\� 1C� a�� 1=��j'� <br />Lo� <br />��In(`1 �P�)��i <br />,TfACH TWO COPIES) <br />n �-���.�-� <br />���� �� �. � <br />\j <br />CONSTRUCTIONLOAN LENDER.ADDflE55.TELEPNCNf':UMBER <br />P�uMeiNa <br />NO. TVPE OF FIXTURE OR ITEM FEE <br />3 WATr?R CLOSET (TOILET) <br />� BATHTUB <br />3 LAVATORY(WASH BASIN) _ <br />I SHOWER <br />'� KITCHEN SINK 8 DISP <br />� DISHWASHER <br />� LAUNDRY TRAV <br />CLOTHES WA^uHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOUR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (FiERVICE — BAR, ETC.) <br />SUB TOTAL $ <br />PERMIT . $ <br />TQ`ALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETPACK � REAR SFT9�CI( <br />�� R <br />� Q tt� <br />USE ZONE� � 1 OT RREA <br />V. <br />�� . <br />HEIGNT IIMWTIpw NOi OF OWELLING <br />i .yt <br />NO Oi <br />ev <br />HE.4TING SYSTEM: �GAS f-1 ELECTRIC f l <br />CONIRCTPERSONANDPHONENO. -�" �^'_ I <br />.,,,,,. .__ . _,�v, r /i,.,-. .,. . <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAM!N�0 THIS <br />APPLICATION AND KNOW THE SAME TO 8E TRUE AND �DRRECT ALL <br />PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TYPE OF <br />WOHK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF /' PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CUNSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THF WORK FOR WHICH <br />APPLICATION IS MADE AND � COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 2962U0 WAC. <br />l � <br />$�1 .--�1„`' �",• �,tir.,�.u__ I- y- <br />�NATIIRE ( ^ , 1 � DATE <br />�� � � � �i �) <br />CITY PUSINESS UCENSE NO <br />NO. TYPEOF�EGUIPMENT � FEE <br />AIC — NHNDLG UNITS — H.P. <br />FORCED AIR S1 oTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />UNIT NEATERS — B.T.U. M <br />CLOTHES DRVERS _ <br />VENTIL4TION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOV� <br />FIflEPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />FXHAl1ST FAN <br />$IDESET�lwA,�/ 71ANCIIELKNUMBEii/� <br />5 l��� <br />VACAN7 SiiE FEES <br />f1Yp5 f i NO BUILOING <br />JF BLDG/I I <br />3'j,. FK U 'RACti * �'LUMOING <br />BASEMEN�T MECHANICAL <br />IWIES fl NO <br />ADD�l10NnL PLAN G��F.CK <br />OtHER <br />STNE BUIIDING SURCH�RGE <br />CITY OF EVERETT rueiir, wo�Ks <br />LOCAL SALES - <br />TAX CODE IS 3105 iOTAL <br />J <br />_�— <br />SUB TOTAL 5 �_ <br />PERMIT S � <br />TOTAL FEE $ ' _ <br />FEE RECEIPTNO. <br />7 � <br />