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� <br /> APPLICIl�TION �OR CONSTRUCTIvN PERMI � <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETI; WA 98201 • (425)257-8810 <br /> �3.DEMOLITION O COMSINATION ❑ BUILDING ❑ MECHANICAI ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: /D.S// —/9�'— �! ��� � WA 9,�:� <br /> �_9��U!d/f'ti//E /�7_l_�=— �`-f , �-------� �' <br /> �,E M�ILAODR 5 ��r z�� ,�__.,::?/�a��.r�_ ��� <br /> TENANT MNL�OpHE55 ��p� � _, __,_ <br /> Z�P PNONE <br /> ANCHITE67 OR OESIGNEH M�IL�DORESS CITY -- -- . -�--- <br /> ZIP PHON} -- <br /> GENEi1�LCONTP�CTOq MAILAD�RE55 CI1Y -"'-'-^- -- <br /> i�� PHpNE ^ [��TE LiCENSC� <br /> MECH�NICALCO"!?a�CTOR M�IL�DIX1E55 ��n. � <br /> Z�� PMaNE STMt�II�EVSE I <br /> � PIUMBINGCON7RAf;7pp MMLADIX1E55 CITY <br /> �' �� ziP GHONE FT.1TF LICFNSE� <br /> � CONTpACTPPoCE FWpqK <br /> ��� S — S G/, HEATING SYSTEM: ❑GAS L� ELECT!�IC ❑ <br /> OESCRIBE WpqN AND SOUARE FppTAGE INVOLVED CpNTACT PEPSONANO PNONE NO <br /> - S 3 •3�/ � <br /> I HEREBY CERTIFY THAT I HAVE READ �1ND E%AMINED THIS <br /> PROPOSEUUSEOFBUIIDING APPLIC.4TION AND KNOW THE SAME TO BE TRJE AND CORRECT ALL <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEG�LDESCRIP71pNpFpqppEpry�S�pIM�BELOWOR�TT�CHTWpCORES� WORK WILL BE COl�PLIED WITH WHETHER SPECIfIED HEREIN OR <br /> ' NOT. THE GRANTING OP A PERMIT DOES NOT PRESUME TO GIVE <br /> . ior y��K pp AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LqW REGUUTINO CONSTRUCTION OR THE <br /> PERFORMAkCE OF CONSTRUCTION.THAT I P:,M AUTHORIZED BV THE � <br /> � OWNER 6F THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> �� � =IS-.� /S • APPLICATION IS MADE AND i COMPLY WITH THE S7ATE <br /> . PARCEL LV(I.U.NUMBER CONTRACTORS LAW 1827 RCW AND�g52U0 WAC. <br /> CONSTRIICTION LOAN lENOEH,�ppqESS.TELEPNONE NUMBER J�, J_ � [�^ <br /> % •� ! (P / / <br /> ' . 51 AT� D�TE <br /> ; „ qTY BUSINESS UCENSE NO. <br /> ;, PLUMBIN6 MECHANICAL <br /> � NO. TYPE OF Fl%TURE OR ITEM <br /> �E NO. TYPE OF EOUIPMENT FEE <br /> � , WATER CLOSET(TOILET) � A/C—q�HNDL6 UNITS , <br /> BA�HTUB ' FORCEDAIHSYSTEMS � <br /> ' LAVATORY(WASH BASIN) � HEAT PUMP A � <br /> - . SHOWER � UNIT HEATEPS , � <br /> � KITCHEN SINK 6 DISP � ; CLOTHES ORYERS <br /> GtSHWASHER � RANGE HOpD '�— <br /> . UUNDRYTRAV � - � ' <br /> , WATER HEi�TER � <br /> . CLOTHES WASHER � WOOD S'ft�VE <br /> URINAL � METAL FIREPLACE(WOOD BURNING) ' <br />� ORINKING FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) ' <br /> FLOOR DRAIN ' <br /> � GAS FIREPLACE � <br /> BACKFLOW PRE�ENTER5 ' GASHANGE � <br /> I - ' <br /> SINK(SERVICE-� HAR,ETC.) � GAS PIPING <br /> � <br /> ' EXHAUST FAN <br /> r � � <br /> � <br /> � �- <br /> _ i <br /> � � <br /> - — ' i <br />� � SUB TOTAL S ; SUB TOTAL S ' ' <br /> _ PERMIT S i PERMIT S � <br /> TOTALFEE S ' TOTALFEE S � <br /> FOR OFFICE USE ONLY: <br /> iRONT SFTPACR FEAR SF.TB�CR SIDE SEfB�LK PUN C11EGR NUMBER FEF AELEIPT NO <br /> r7(�f b <br /> USE]ONE 1 OI�REA v�cnNr srt¢ FEES VALUATION FEE <br /> ❑YES i <br /> ❑ NO �— <br /> "— BUIl01Nf, <br /> HFIGHiIIMITATION NO.OipWELLIN(: SIIEOFBLDGRI ' <br /> IINIi$ — � <br /> PlUM01NG <br /> OCCIIPANCY Np(1[SfORIkS OCC4P�NT LO�p B�SENtNI � � <br /> GROUP MECupNICnI i <br /> ❑YES ❑NO � —_ " <br /> FIRESPRINKLEqREO'D RFASON ADDIIIpNAI.i'IANC��f.CR i <br /> i <br /> FIRE A V.RM REO'D OiNEP � <br /> RF4C�V <br /> STAIE BIIILDMG$U1ICIIMGE <br /> 1YPE Of f,ONSi PIPNSAPPPOVEDBY �Ry OF EVERETT PIIBIIf.WORKS T <br /> LOCAL SALES —.�__ <br /> u..e TAX CODE IS 3105 TO7AL <br />