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APPLICATI�N FOR COPISTRUC'�ION PERMIT <br /> CITY OF EVEHETT• BUILDING DIVISION <br /> 32U0 CEDAR STREET• EVERETT,WA 98201 •259-8870 <br /> ❑ DEMOLITION O COMfiINATION , ,'�`,BUILDING , ❑ MECHANICAL '�'PLUMBING ❑ SIGN <br /> PROJECT ADDRESS � <br /> ��z� /I'- /�-P J <br /> ON7JEF Q� r MAILADDRE55 CITY ZIP PHONE <br /> C�/�///G <br /> TEN/�M { MAIL/�DDflE55 CITV ZIP PIIONE <br /> , � <br /> ARCMITECTOROESIGNER MALADDflE55 ' CITV ZIP oHONE <br /> GENEAALCONTqACTOR MAILADDRESS CITY Z�p PHONE STATEUCENSE� <br /> �''7�✓EN BR/LTLocv L'on/Sf. 3rf//-/22�G,�E, E►/6RE1T �'i8zo8 337Ao79 �YEJ�8�2�ZSR <br /> MECHAhICAL CONTRACTOH MNLl�DDRESS LI7V ZIp PHONE SiATE UCENSE I <br /> _ ..___ <br /> PLUYBWGCONiRACTOq----MN�/,DDREgg—'—"' ----'—'CITY'— -" - 21P PHONE STATE UCENSE� <br /> COMiUCTPRICEOFWOHK • — <br /> HEATING SYSTEM: �!'GAS ❑ LLECTRIC ❑ <br /> �ESCBIBE WORKAND S�W�IE FOOTA6E WVQWED pONTACT PEHSONAND PHONE N0. <br /> �t/E BART,4o�•✓ —� 337- 4079 <br /> I HEfiEBY CERTIF'� THAT I HAVE READ AND EXAMINED THIS <br /> � aaoaasEo use or��mtniNo�j � APPUCATION AND KNOW THE SAME TO BE TqUE AND CORRECL ALL <br /> � � � � !��Rw . , PROVISIONS OF LAWS AND ORDINANCES GOVERNING TH!S TYPE OF <br /> IEGALDESCRIPT10NOFGROPERI'�SHOWNBELOW n�cN co ies - WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> r, . � ,� . � NOL THE CaRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or � �U BLOCK �OF /� ���� �UTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � :'EHFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> .. OWNEA OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> . APP�.I:.ATION IS MADE AND I COMPLY WITH THE STATE <br /> rr,ace�7nx i.o.NuueEA — CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> COry�TFiUC110N LOAN/�-ER,�DOr�dS,lELEPH��uyA�^7�5�33 SIGNATUfl—r'�, O E //_�� <br /> L� N rriH <br /> CIN 9US!NESS LICENSE N0. <br /> PLUMBINO � - MECHANICAL I <br /> N0. TYPE OP FXTURE OR ITEM FF:E N0. TYPE OF FIXTURE OR ITEM FEE I <br /> � ,3 WATER CLOSET(TOILEn � A/C—AMNDLG UNITS—H.P. � �, <br /> B�i HTUB � ; / FORCED AIR SYSTEMS—B.LU. M E.A. ; <br /> 3 LAVATORY(WASH BASIN) i HEAT PUMP �— <br /> �SHOWER�� � , � UNITHEATERS—B.'•.U. M � '� <br /> / KITCHEN SIDlK 8 DISP i CLOTHES DfiYERS ; <br /> DISHWASHER � VENTIL:TION FAN � <br /> LAUNDRYTRAY ; RANGEHOOD ' <br /> _/ �- -.CLOTNES WF�SHER �� � � WATER HEA7ER � <br /> _ � URINAL"' � WOGD STOVE ~ <br /> _ � . '.DRINKIN�FUUNTAIN� I METAL FIREPLACE(WOOD BURNING) ; <br /> _ ' 'FLOOR DRAIN � � FIREPLACE INSERT(WOOD BURNING) � <br /> _ 'BACKFLOW I°REVENTERS ; GAS FIREPLACE ' <br /> _ � SINK(SERVICE—BAR;ETCJ � OAS RANGE � <br /> _ � ' GAS PIPING � � <br /> _ - i EXHAUST FAN ; <br /> � i <br /> i i <br /> _ i , <br /> — � i <br /> � SUB TOTAL S i SUB TOTAL S ' <br /> _ , <br /> PERMIT ffi i PERMIT S i <br /> TOTALFEE $ � TOTALFEE S � <br /> FOR OFFICE USE ONLY: '' <br /> FRONTSETB`40r � . REAR6ET6AC� SI�ESETBACN �/ PUNCMECBN�EP FES�v RECEIPTNO. <br /> �/C� V/ � � y(O p, y � ./��� �� <br /> USEIANF._, � ' l . LpTMEA��� / v�Curi E FEES VALUATION FEE <br /> �"�'��../ <br /> �� [ — � ��CI. v OYES ❑ No euaoiNo �aus �D I OJ <br /> MEIGXTLIMITAiION ' ' / . NO.OFOWEWNO 5¢EOFBLWrtI. � � <br /> .��; UNITS ' /(7� SS LIJi� PIUMBING � !/ i �i(� <br /> OCCUPM�CV NO.OGSTOPIE4 OCCUPANTLpAO BASEMENT <br /> Gfl UP . MECNMIICAL - <br /> r.-�--� <br /> -3 ��' �:'Z�. . OYES O � <br /> AUDITIONAL PlM!CHECK � <br /> FIREAL/31MREQU�.;'. . . REASON � i <br /> . j�,', :�i . . <br /> T <br /> . ,. .� ' ,� on�eR �� ;�- <br /> FIRE SPRINI(LER pEQ'D'�- REASpN <br /> i <br /> . - � � ' �� SThi E 6UIlDINO$l1RCH/J73E ��i , <br /> i..� .:' <br /> TVPEOF ONSL , PlµSi1PPPOVED Y � <br /> w� r �� CITY OF EVEREIT PUOUC WORK9 }-; � �,,–. <br /> ;i I-� `/�G LOCAL SALES <br /> � o�re 3_ 7 SS � TAX CODE IS 3105 TOTAL � � -'� <br /> 1��.j �: . <br />