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APPLICATIO�� FOR CONSTRUCTl �N PERMIT <br /> � CITY OF EVERETT� BUILDING DIVISION <br /> 3200 CEDAR STREET+ EVERETT, WA 98201 •259-8810 <br /> C7 DEMOLiTION (l COMBINATION fl BUILUING MECHANICAL PLUMBING f�1 SIGN <br /> PROJECT ADDRESS <br /> „ a -, �� 1`� �r�;✓e V�� ��f�1`c��� n��c�< <i <br /> OWNEH ``MAILAOOfI'c5S CITY 1 ^ZIP PHONE <br /> XEI � IPR� �C1MeS L�.`A�R�SS I� �Tlle1�'EVLI YQ7� Mi�\�� �ZI1JO�e,�,9stP oNa � Q�' �� 5 <br /> ARCHITECTOROESIGNER MAIIAD�pE55 CIN ZIP PHONE <br /> GENEFlALCONTRACfOR MAILAD�f7E55 QTY 21P PIIONE l�g�_��biSAi.ELICENSE� .. . � <br /> �/Mek�� �4omesL��. 1Ss��''_�_"3o�e\\ - �verP�S- �J Z3o��,e�1 �,ko�a MET-C�oc-a4 K'� <br /> MECH�NIC0.L CONTRACTOP MAIL RD�RESS CITy ZIP FIIONE STATE LICENSE� <br /> I�u c�c�_� NPA�-;n c, _ <br /> PWMBIN ONTRAf,TOR MA OPE55 CITY 21P p110NE STATElICENSEI . <br /> ' 3aa ;i`' - = r -a- � o - I� (�oo-�57- �s <br /> CONTR�CT PRICE OF WORK � <br /> HEATING SYSTEM: GAS fl ELECTRIC f-I' <br /> OESCRIBE WOR'AND Ol1ARE FOOTAGE INVOLVEO GONTPLT PER50r�ANO�PIIONE NO. <br /> " �� /� J�-.-�' Y! r �l�-� /�!''/` � -� /cfu— 5 rlT 'DZIv <br /> �� ru `� ' � T <br /> `��a � �Q�?-�a � I HEREBY CERTIFY THAT I HAVE READ AND ExAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSEO USE OF6UILDING PROV�SIONS OF LAWS AND ORDINANCES GOVERNING TNIS TYPE OF ' <br /> YYl U� � - - � C 'N'�� ` � � � 'S WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � IEGALOESCpIPTIONOFPROPERtt� IOWNBELOWORARALHTWOLOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT'�BIOCN oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION- OF ANY <br /> / O1HER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> / - . �( ' C 1�� � D �'(J O PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOpRED �Y THE <br /> OWNER OF THIS PqOPERTY TO PERFORM THE WORK FOR WHICH <br /> n �' '/ ��`� ��lf 2 „3 . Cc� APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCELTA%I.D.hl1MBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTflI1CT10Ni0ANlENOER,ADOflE55.TEtEPIIONENUMBER � .""���',��_ v %��/~7� <br /> SIGNATUflE TE <br /> C17y BUSINESS LICENSE NO. <br /> PLUM67NG MECHt.NICAL <br /> NO. TYPE OF FIXTURE OR�TEM FEE NO. TYPE OF EQUIPMEHT FEE <br /> � � � WATERCLO5ET(iOILET) i A/C—A/HNDLGUNITS—H.P. � . <br /> 3a BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> i <br /> ,�j, LAVATORY(WASH BASIN) � HEAT PUMp �— <br /> � <br /> SHOWER ' UNITHEATERS—B.T.U. M � <br /> �� KITCHEN SINK 8 DISP � i� CLOTHES DRYERS � <br /> --�— <br /> � DISHWASHER � VENTILATION FAN i <br /> LAIiNDRY TRAY � RANGE HOOD � <br /> i <br /> CLOTHES WASHER � p WATER HEATER i <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN i . METAL FIREPLACE(WOOD BURNING) � <br /> FLOOA pRAIN � FIREPLACt INSERT(WOOD BURNING) i <br /> BACKFLOW PREVENTERS � � �p GAS FIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) � _� GAS RANGE � <br /> ' � GAS PIPING � <br /> i EXHAUST FAN T— <br /> � �— <br /> � � <br /> � � <br /> � , <br /> SUB TOTAL $ ; SU6 TOTAL $ ; <br /> PeRM1T $ i PERMIT $ � <br /> — _,— <br /> TOTAL FEE $ ' ?OTAL FEE 3 � � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETOACK REAf15FT04CH SI�pSETOaCR PIANCIIECK!ltIMOER FEE RECEIPTNO. <br /> !�`'`�/7 <br /> IISEZONE IOTAf1EA VACRNISIif FEES VALUATION FEE <br /> I IYES I i 110 UIIIIOIHf+ <br /> — � <br /> HEIGIITLIMITATION NOOFOWELLING SIZEOFI1lOf/(I '— - � <br /> UNI�$ PI.UMQING �h��—� <br /> G�COUPANCY NOOPSIONES OCCUPANTIOAD UASEMENi MECI1FNIf.AL —��� ) F— <br /> IIYES 11 NO — — . - � <br /> ('IRE AURM REO➢ �EASON Af1DI110NnL PIAN CIIf.CH � <br /> � <br /> i <br /> OIIIER � <br /> FlRFSPRINKIERflEO'� fIFASON — <br /> I <br /> SiA7E OIILL�111G SIIqCllnfl�E j <br /> I <br /> �__ <br /> TYPEOFf,ONST PIA!lSAPPROVEOOY CITYOFEVERETT P1101�f,W00N5 ' <br /> i <br /> LOCAL SALES � ---- �; ;— <br /> __ uatE TAX CODE IS 3105 TOTAL �� ,� i� , � <br />