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APF9LICATIGn! FOR GOPISTRUCT�ON PERIIAIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 320o CEDAR STREET• EVERETT, WA 98201 • 259-8810 a <br /> � / � <br /> fl DEMOLITION '� COMBINATION �I BUILDING n MECHANICAL r 1 PLUMBING f ! SfGN �� <br /> PROJECT ADDRESS F.� 2 , I <br /> ��►� I3' �� A�k. � ���,v�c v��-� <br /> OWNEP MFILA�DR�55 Cltt ZIP PHON[ <br /> f�l-1,jtc� yr>me� L �.C. I��I�� P��Il�rtl- tu�c�.�-1� Iluti����l't�i l� �l&Ola (�Y9)�I(f (1.��r1 <br /> TENRNT � MAII_AODRF55 CIiY 21P PIIONE <br /> ARLNItEGTOR0E51GN[R MAlIA0�RE55 CITY Zit' pHONf- <br /> G�EN�E'(l�l GONTRnCTOR MAILADOR\ESS CILY ZIP PIIUNE STAiE IICLNSE� <br /> c.i,�� CI�Y�/l' 1 <br /> MECHANIC4LCU4TPA TOR MAILAODRESS (;IN ZIP PI10�`lE STAiELICENSE� <br /> , ti+ � � ���u �: F?�,X 3�r 1�.Ct,c���.�,��+ns �i�a5y 33t/- `/ll ! Rnr�.� �-���(����1 <br /> PLUMBP G CONiRAGTOR Mnll nODRESS CI71' ZIP PHONE ST�TE ICENSE• <br /> 1 �_� � , . , �� ����91 S.�- �/.� 06 '..��'-�y85 � � 61�4 0 �� <br /> coNrnncT rnice oF wonK <br /> � <br /> HEATING SYSTEM: �GAS �1 ELECTRlC f 1_ � I <br /> OESCRIBE WO K AND SOU�RE FOOTA�IN.VjO�VE Cp TACT PEF^01 dND PH E NO. <br /> C��, . � _ <br /> �-�a�i'r lal�l _ 1l�- Oalnl -� �cf. 31 <br /> I HEREBY CEHTIFY THAT I HAVE REA.J AND EXAMINED THIS <br /> APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT qLL <br /> aaoroseo use pF ev^niNc PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> _�ZC�I ��Qf`�4�G�.C. WORK WILL BE COIAPLIED WITH WHETHEF SPECIFI;D HEREIN OR � <br /> LEGALOESGRIPTIONOFPROPERTY�SHOWNOE'_OWORATfACHTWOC1O,PIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRE�UME TO GIVE <br /> �or 2 BLOCH_ � OF G'� � V' V AUTHORITY TO VIOLATE OR CANCEL THE PROV.SION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> C��Q..� �Uc�)�-S �� �i � �'�( (� ' � PERF7RMANCE OF CONSTRUCTION.THAT I AM AUTHORIZEU BY THE <br /> OWNeR OF THIS PROPERTY TO PERFORM THE WORK FOP WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STA"fE <br /> PARCELTA%LD.NUA!BER CONTRACfORS LAW 1827 RCW AND 2962G�WAC. <br /> Sc - U )l� - b3 -C�)Ol ///��� /� <br /> CONSiFUCT10NLOnN IENDEP.AD�RE55.TElEPNONE NUMBEq X� �Q�/ �J � <br /> SIGNP. pE OnTE <br /> CIiY F1USV:t:S LICENS[NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATEH CLOSET TOILET � ---- o �— <br /> ( 1 A/C—A/HNDLG UNITS—H.,. � <br /> BATHTUB ; FORCED AIR SYSI EMS—E:T.U. M E.A. � <br /> LAVATORY(WASH DASIN) � HEAT PUMP ��— <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> I KITCHEN SINK&DISP i I CLOTHES DRYERS � <br /> DISHWASHER VENI�ILATION FAN —i— <br /> LAUNDRY TRAY ; RANGE HOOD <br /> CLOTHES WASHER � � WATER HEATER � <br /> URINAL WOOD STOVE <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN FIREPLACE INSERT(WOOD BURNIIJG) � <br /> BACKFLUW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ; GAS PIPING � <br /> � ' EY.HAUST FAN ' <br /> i � — <br /> SUB TOTAL 3 � SUB TOTAL S <br /> PERMIT 5 i PERMIT :u i <br /> TOTAL FEE S � TOTAL FEE S <br /> FOR OFFIGE USE ONLY: <br /> FRONiSE70nCK G REnRSET�� SIOESETO.•� PI�NCII\E7CN1Jl11dpFP FEE/Ja � R[cEI;iC� ., ' <br /> 2 .� 5�'�7 ��: � r, <br /> usezoNe iornnen '�7/ VACR/Ni51iE F ES VALUATION FEE <br /> — -� �S / L 6�YE$ fl NO OU�IDING �j �/�i �,9) <br /> HEIGHTLIMITATIONr NO.OFDWELLING SIZEOfBL I <br /> � �sF� <br /> Z� uruirs � Ibb"Z �� C�v�.J4 f r�uuAwc � <br /> 4�� sf c.�e.�,4E 9i ioo <br /> OCCUPANCY NO Oi510PiF5 OCCUPAM L040 BFSEMENi � <br /> Pf10U ^ � MECHANICAL <J i �%Y_� <br /> �3 (f-/ L IIYES ✓NO — <br /> i <br /> FIRE ALA!iM REO-D Rf450Y ADOIIION�L PI.AN CHF.CK <br /> —�_— <br /> OIIIEfi <br /> PIRF.SPqINNI.ERFEG'D RfA�ON <br /> STAtE 9UilDIt1G SURCNnRGE ��� <br /> _�:i'_J <br /> rvrFocr,or+sr vinNsnrrn�eo�v CITYOFEVERETT �uei.ir,wonKs �Q � �,J <br /> _,� � ,I � LOCALSALES � - <br /> -!v i�nTE p -� 9� TAX CODE IS 3105 TOTAL �3� ��� <br />