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� . <br />� APPLICATIV�I FOR COPlSTRUC'� rON PERMI'�t <br />,� CITY OF EVERETf • BUILDING OIVISION <br /> f 3200 CEDAR STflEET • EVERETT, WA 58201 • 259-8810 ' <br />� f 1 DEMO�ITION i I COMBINATION I I BUILDING I I MECHANICAL � 1 PLUMBING f I SIGN <br /> PROJECT ADDRESS I <br />' ,3- $ �3 �o �,D,E' ul�si <br /> owNen rnnn.nnonr.ss r.m zm r�iane <br />! ,�/P�is;�wl �,�ri�f5 7o z3 zs9''�- r�%s,�/.�,��d 9�'o z� s�b'.��0 6s <br />' TENANT MNI.AOOPESS ���Y ZIV PHONE <br />� qRCHITE:TORI)ESIGNEI� ldplLA��Fi55 GIY ZIP � PHONE <br />� C�i�i/.;s l�'� �C1 �ox _1�06 -_��sf,il�/ftL 3s'�'- �ZZ�9 — <br /> CEN�ER1ALCON'i��CTOP MAIL����ESS GtV ZIP PNONE SiATELI:'ENSEx <br /> �Jc'C'/.S�(�,/ ,(�(1'n>rS 7o Z.��'-'�L C. _ S/E � �k// _ s�c//�'v���:� <br /> I MECMANICAICONTi1�CTOR '�AILAOURE55 CIIV 7.If �'�IONF. �1AT[LICF.NS[x <br /> I �X/-�7f f �' /C'/�J'/.'t/S� __ — .�iJ� ���� .--_ <br /> PLUMpINC CONTR�CTOR 1pIL AODRESi C�iV ZIP PHONE ST�TE LIC!1NE'=M <br /> /v'id fi� ��i/n,'r�i� -- — <br /> CONTRACT F�ICE OF WORK <br /> _��/� � HEATING SYSTEM: f,�! GAS I� ELECTRIC Cl_= <br /> OESCRIDE WOf'KAND SOl1ARE FOOTAGF IHV0I.VED C'INTAGi V[PSONAND PHONE N0. <br /> r S-r:/1 /.� i� _ — �-- <br />� - � �� -_. ��{�f _-- <br /> I HEREBY CERTIFY TNAT I HAVE READ AND EXAMW[U THIS <br /> -- — APPLICATION ANU KNOW THE SAME TO BE THUE AND CORFECT.ALL <br /> PROPOSE�USE OF OUIL�ING PROVISION" OF LAWS AND ORDINANCES GOVERNING TNIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGN��ESCRIPTIONOFPROPEFTV�SH0IYNBELCWO rrnci{n��ocovi NOT. THE ��RANTING OF A PERMIl OOES NOT PRESUME TO GIVE <br /> LOT�BLOCN OF <br /> � .� AUTHOPI'� TO VIOLATE OR CANCEL THE Pf70VISI0N OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSI�RUCTIOf!OR THE <br /> I j , (�j �' PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK �OR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> PARCELTA%ID.NUTABER <br /> CONSiRUCTIONI.OFN LENOEA.AD�RESS.TEIEP`IONE NUM9ER X_��� 5�6�9� <br /> SIGNATURE ��F <br /> GRY�t/�M[SS LICENSE 110. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> 3 WATER CLOSET(TOILET) �/� � AIC—A/HNDLG UNITS—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 /> KITCHcN SINK& DISP i CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAtJ ' <br /> LAUNGRY TPAY / RANGE HOOD � <br /> ( CLOTHES WASHER � WATER HEATER ' <br /> URINAL ' N'OOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOF DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> OACKFLOW PREVENTERS ; GAS FIREPLACE � �� <br /> SINK(SERVICE—BAH, ETC.) � GAS RANGE ' <br /> — � GAS PIPING � <br /> ; EXHAUSTFAN / <br /> i � <br /> SUB TOTAL S '' SUB TOTAL 5 �— <br /> PERMIT S i PERMIT 5 � <br /> II TOTALFEE S � TOTALFEE 5 ' <br /> ° r � CLtCL� � G� <br /> FOR OFFICE USE ONLY: I�29.� C'�.1/GL(�-CGG � " i� <br /> FFONTSF.TE)ACH R[MSF.TIl N SIOESET�DA-G+K PUNGIIECNNUMiI'�i �EE— ^ /3 ^�CEI1N0. � <br /> ��l /���//� c7 � 7 `J� � ? � <br /> usef��.1,e�✓f�i i.ornraen�/ / vncnnrsire FEES VALUATION FEE <br /> /`� e7� � �/ (o C� nves :� No ouuoiN� Cjz 68$ �O�-%J� iV / � <br /> i <br /> neicrrtun�irmioN � No oroweuwc size�ru�oc�� �7 i <br /> �� � uNirs ��ZG, SF `Nn.i4 ��1- ❑�uMoiuc <br /> 56 �S GA 4G.". i <br /> OCCUPANGV NO CL SiCRiES OCCUPPNT LOAD �/+SEh1E11i MECNANICAL � � <br /> Gn r� � A / � — i <br /> �v IlYES . �0 i <br /> �001 fIONPI PIAN G��[CK <br /> FIFLPLAFMREOD REASON <br /> /D I <br /> ____ OTHEF h��N �_ <br /> i <br /> / / � i <br /> FIRE SPRINNLER RFO'❑ RF�SCN ��/� <br /> STATE�UILDING SURGHARGE C <br /> TYPEOFCONST. PLANSAPraqvEqev CITYOFEVERETI' ruoucvronKs LD � <br /> 'J {�' LOCAL SALES —7 7 )I,c— <br /> ��/� DATE ZU�S 5 TAX CODE IS 3105 TOTAL / <br /> --- �� <br />