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APPLICATION FOR �ONSTRUCTeON PERNlIT <br /> CITY OF EVERETT• BUILDING DIVISION <br />` 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> I-1 DEMOUTION fl COMBINATION rl BUILDING f�MECHANICAL �l PLUM@ING f 1 SIGN <br /> PROJECT ADDRESS <br /> / looS - /6z'' �1vE �sE Eve�erT <br /> OWNEP MaILA0DRE55 CITV 21P PHON[ <br /> I �nq�naers 1n�esTiue«TS lft.�oy l7� PL N [✓ �Sen.tl�e 98/ �7 <br /> TEN�NT MAILA�ORF55 f.ITY 21P FIIONE <br /> ARCHITF.CTOFUESIGNER MAILAD�RESS CITV IIP PNONE <br /> GENERALCONiMCTOR MAILA�ORE55 ❑IV ZIP PiIONE $iATEUCENSE� <br /> GFS /�l�ar:� Soo E �nnair� r�n/ae `/8Z7Z 79y- 7,3oG GSHEACI-/VXJD <br /> I MELNANICAICONTRACTOR MRIIADDRE55 Qtt ZIP PPDNE 5T4TElIC[NSE+ <br />' PLUMBINGCONiRACTOR MAILAODRE55 CIiY 21P PNONE SiAtELICENSEv <br /> G.i� � <br /> CONTRACT PRICE OF WOf1H <br /> i HEATING SYSTEM: f l GAS �l ELECTRIC fl <br /> I DESCRIBE WORK AND SOIIARE FOOTAGE INVOLVED f.0�lTACT PERSON�ND PHONE N0. <br /> I <br /> %�G K <br /> � � T/�n� I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO 115E OF BUILDIN APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCE.i GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALOESCRIPTIONOFPROPE41tt�SHOWNBELOWOPRRAGNTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUM[ TO GIVE <br /> �oT eioc� oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPIICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTA%I.O.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTFI/CTION LOr1N LENOEH.R�DRE55.TEIEPMONE NUMBER x���}y � /A�`��� /�/Z 7 %f.J <br /> SIGNATC1SiE O�TE <br /> CITV O1151NC55 LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> �T� <br /> WATERCLOSET(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 � �/ CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRY TRAV ; 9 RANGE HOOD ' <br /> CLOTHES WASHER � WATER HEATER <br /> URINAL ' WOOD STOVE ' <br /> DRINKINCi FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i _ <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BUFNING) <br /> BACKFLOW PREVENTERS ; GASFIREPLAGE � <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE <br /> ; GAS PIPING ; <br /> � 3Z, EXHAUSTFAN <br /> � <br /> � � <br /> � <br /> � <br /> SUB TOTAL 5 SUB TOTAL 5 , ] ; <br /> PERMIT 5 � PERMIT 5 � i <br /> TOTAL FEE 5 ' TOTAL FEE 5 / ' <br /> FOH OFFICE USE ONLY: <br /> FRONTSFTAACK REARSFTBACN SIDESETO/.CN �'I�NCII[CNNt7)AOF.F �[F PECFIPTNO <br /> L '' <br /> i� � <br /> usezoNe �oranen vncnnrsire FEE VALUATION FEE <br /> _.—�-- <br /> nves n No aunoir�c � <br /> I <br /> IIEIGIITLIMITATION NO.OfDWELUNG SIZEOFBLDGRI <br /> UNIiS PWh1�31N9 <br /> __-1_ <br /> OCCOPANCY AO O�StOmES OGCUPANTLOAD BASEMENT � <br /> �ROUP MEC114NILAL j <br /> IIYES Il NO <br /> FliiEALAR�AREO'D RFASON �ODI110NALPL\NGNfCK <br /> i <br /> OtHER � <br /> FIRESPRINKLERHFO'D FP450N <br /> _�_— <br /> SLNE 81➢LDWG SURCIIARGE � <br /> IVPFOFf,ONST PinNsarrnoveoov CITYOFEVERETT �IIPIiCWOt1KS --r <br /> LOCAL.SALES —�-- <br /> �qTE TAX CODE IS 3105 TOTAL � <br />