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- ,,-, <br /> APPLICATIOrI FOR CONSTRUCTrON PERMIT <br /> CITY OF EVERETT• B�ILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> fl DEMOLITION fl COMBINATION f'1 BUILDING MECHANICAL r� pLUM81NG f"i SIGN <br /> PROJECT ADDRESS <br /> i � � �� <br /> OWNER MRILRUDPESS Cltt ZIP PNONE <br /> �QUE df1LUE 1f�'Dcr/�RE I/D/� �lE� f����rtY E��ae'H'r 7'S%l�' ���3ya3 . <br /> TfN�NT 4AILAppRE55 CITY ZIP CHONE <br /> ARCHITECTORDESIGNER MRILAO�RE55 CITY 71P PHONE <br /> GC�HI//NE7 T��N9T,MAILR�I� /�����L � CI(Y�� Z�� ��S�ZII� STh7ELl,^,ENSEr <br /> MECHANICALCONTRACTOR MAILADpRE55 CIN ZI� PIIONF ST�TEUCENSE� <br /> �S1 <br /> PLUMBIl:�CONTRAf,TOR MAILADORE55 CITY ZIP PHONE STAiELILENSE� <br /> CONTRACT PRICE O�WOqK <br /> HEATING SYSTEM: D(I GAS f 1 ELECTRIC fl <br /> ����700501fqE FOOTAFt INVOLVEO LONTRCT PERSON ANO PHONE NO / 7SL� � <br /> vlc_ <br /> c G <br /> /�vsTst�c C' e � <br /> / 7 7S�('jO /� � G GOO �TU I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSE�USEOFBUILDINC PROV SAONS OF DAWS AND 0 DANANCES GOVERNING 7H SR7 PE OF � <br /> �����' ��� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALOESCRIPTIIXJOfMGPERTV�SHOWNBELOWORATTACHTWOCOPIES� NOT. 7HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> iOr e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> _ PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICAT''�N IS MADF AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.D.NUMBER CONTRA(:TORS LAW 1827 RCW AND 296200 WAC. <br /> �r" / <br /> CONSTRUCTIONIOANLFNDEH,ADDRE55.TELEPHONENUMBER x �/-��' y� <br /> SIGNATURE TE � <br /> ' CITY BUSINE55 LICENSE NO. <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. ^'�PE OF EGUIPMENT FEE <br /> � WATERCLOSET(TOILET) � /VC—A/FiNDLGUNRS—H.P. � . <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATOPY(WASH BASIN) � HEAT PUMP i <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 6 GISP i CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRYTRAY ; RANGE HOOD ; <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL � WOOD STOVE ' <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PRcVENTERS ' � GAS FIREPLACE ; <br /> SINK(SERVICE—BAR.ETC.) � GAS RANGE � <br /> GAS PIPING <br /> � EXHAUST FAN � <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL 5 �/� ; <br /> PERMIT $ � PERMIT $ /��— <br /> TOTAL FEE $ � TOTAL FEE $ a ��—� � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETPACK REAR SFTBACK SIDE SETBECN PL�N CHECK NUM�ER FEF �ECEIPT h0 <br /> � `� <br /> usezoNe �ornaen vnenNrsire FEES " VALUATION FEE <br /> f�YEi fiNO BWL�ING _—T— <br /> _ � <br /> NEIGHTLIMITATION � NOOFDWELLING SIZEOFBi0GR1 i <br /> UNITS PLl/M01NG <br /> _— { <br /> OCCIIPANCY NU OiStORiES OCCUPA47lnRD BASEMENi � <br /> GROUP MECHANICAL <br /> i <br /> 'IVES f� NO - <br /> FIRE�UPM REQl1 iiF.ASON n0UI110N�L PI4N CHF.CK i <br /> _ ___�_ <br /> OTIIER i <br /> FIRESPRUJNIERPEOD FE�SON — <br /> Si�iE DUII�ING SURCIInRGE <br /> i <br /> tvveorr.oNst rtnu;nrrnavennv �C�TYOFEVERETT rueim,wonhs � <br /> LLICAL SALES —1-- <br /> ��,,,� _ TAx CODE IS 3105 TOTAL _ ; _ <br />