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APPLICATOON FlDR CONSTRU�CTrON PERMIT <br /> CITY OF EVERETT• BUII.DING DIVISION <br /> 3200 CEDAR STREET• EVERETT, VJA 98201 • 259-8810 <br /> f� DEMOUTION fl COMBINATI04 fl BI�ILDING .=�'MECHANICAL i 1 pLUMBING fl SIGN <br /> PROJECT ADDHESS �-y � �^ <br /> ✓1z7� IU� U�r���i�P �.LJ #. /,'� <br /> OWNG?q /q/ MAl1,qDDRC55 CITY ZIP PHpNE <br /> � �X L ��_� ��_-� <br /> TENANT MNLADORGS$ GiY ZIP PHONE <br /> ARCHIIfCTOR�E5IGNF.R MAIIqDGRE55 Cltt 71P PHONE <br /> GENERFLCONTR�GTOR M�ILAppRESS CIfV pIP PNON[ SIAiELICENSE• <br /> MECHANIC4LCON7R4C�OR MAIL4��RESS CITV 71F PIION[ SiR[UCFN$E� <br /> ��� PI„� ����. 4� P� �� ��.�ck� Ise �1�� 9�t�� ��-75-�9 /�Al ' aAN/yJ��/ <br /> P.UM9INGCONiRAGTOR MnILA0�RE55 CIiY ZIP PHONE STATLLIGENSE• <br /> CONTRFGT PRICE OF WORK <br /> HEATING SYSTEM: f I GAS �l ELECTRIC f 1 <br /> DESCRIBE WORk AN^�50 AR[1FOO��GE/Iy0�(ILVED I (1 CONiACT PERSON AND ANONE ND. <br /> FI� Y.T/ f 4�• ♦ / �Dr 1�� <br /> I HEREBY CERTIFY THAT I HFVE READ AND EXAMINED THiS <br /> PPOPOSED USF O�DUIL�ING APPLICATION AND KNOW THE SAME TO 6E TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �ecn�oescairnoNOFvaoaearv�sMowNee�owoaanacNTwocories NOT. THE GRANTING OF A PERMif DOES NOT PRESUME TO GIVE <br /> � �or e�oce or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRIiCTION.THA71 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTN(I.D.NUMBER CONTRACTORS LAW ip2�RCW AND 296.200 WAC. <br /> CONSTRIICTION 1.04N IEN�EP.A�DRESS.TELEPMONE Nt/MAER x �l y.�.L�-vr � ,.y�, <br /> SIGNATUriE pq� � <br /> > <br /> CI7V DUSINE55 LICENSE NO. <br /> PLUMBING MECHANIC4L <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EqUIPMENT FEE <br /> WATERCLUSET�TOILET) � A/C—A/HNDLGUNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES ORYERS ; <br /> DISfIWASHER � VENTILATION FAN i <br /> LAUNDRY TRAY ' RANGE HOOD � <br /> �� CLOTHES WASHER � WATER HEATER T— <br /> URINAL � WOOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIREFLACE(WO�1D BURNING) � <br /> FLOOR DRAIN FIREPLACE INSERT(WOOD BURNING) � <br /> _ BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERVICE—BAR, ETC.) � GAS RANGE <br /> � GAS PIPING � <br /> � EXHAUST FAN ; <br /> ' � <br /> � I <br /> SUB TOTAL S ; SUB TOTAL 5 <br /> PERMIT S � PERMIT 5 � <br /> TOTAL FEE 5 ' � TOTAL FEE $ � I <br /> FOR OFFICE USE ONLY: <br /> f RONT SF.TAACK REM SETeAGN SI�E SE7BnCK t'1A11CUFCK NfJMOGR✓ �[F RFCFIPI NO <br /> G�J o � � �� i <br /> usezonE �ornnEn vaCaNrsire FEES VAI.UATION FEE � <br /> 1 I YE$ f I NU -�- <br /> - OUILOING i <br /> NEIGIITLIMIiATION NO.OiDWELLING SIZEOfpL�GRI <br /> i <br /> ❑Nli$ PLIIMOING � , <br /> OCCUPANCY NO OLSIORiES OCCUPANil0A0 BASEMENT � <br /> GNOIIP I MECIi4NICnL <br /> lIYES II NO <br /> FlREALAfiMREO'D qFA50Y ADpI11pN�Lt'LANC�If.CY <br /> T <br /> Oi11ER � <br /> fiPFSPPINNLGfiREO-D RP4Fpk <br /> � <br /> STNE f1UiIDIr1G SURrllnfiGr i ' <br /> i <br /> ivreorr.oNsr m.nHsarrnovennv CITYOFEVERETT rumir,wonKs '� <br /> LOCAL SALES -- — ---- - — <br /> unrt TAX CODE IS 3105 io7AL <br />