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aPPLId:/�iTlLrd FOF� COIdSTRUCI eON PERNlIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 E` � <br />fl DEMOLITION fl COMBINATION I l BUILDING (� MECHANICAL � 1 PLUMBING ( 1 SIGN <br />PROJECT ADDRESS �/ D� / A d�Er IA� �i`�Y ��- "� de�-R'f"�` I,L a-- . yS'�D � I <br />41L AODRE55 �L <br />SD N l�U� � <br />A! /( �I�l_E <br />ARCIIRFGT 01 <br />CITY <br />zir r��oNc <br />w _ , »� 3s 3 �o� 7/ <br />l�p PIIONE <br />nr <br />GENERALGONTpAGTOR MRIL��URE55 CILV ZIP PIIONE STATEI.ICENSE� <br />MECH�NICALCONTR�CTOR MRILADOPe55 � Cltt ].IP PHONE STATEUCENSE� <br />PLUMPINGCONiRACTON MAILAODRE55 <br />CONTqACT PRICE OF WOf1N <br />W <br />� <br />LOTALDESC�ql��pf-��KFTVISNOWN6E-�OW ATiAGNTWOCOR(SI� <br />G-¢�-�� G <br />�/�( ���� �%l l G�/,����5 Gr�, <br />��D(o� Op/�p/�-oovo (�6G� <br />PARCELTA%I.D.NU6IBER <br />CONSTRl1CTI0N IOAN LEN�EIi. ACCRE55, TELEPHONE NUMBER <br />NO. TYPE OF FIXTURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />SHOWER <br />KITCHEN SINK 8 DISP <br />L/IUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DFiINKING FOUNTAIN <br />FLOOR DRAIN <br />�ACKFLOW PREVEN'ERS <br />SI�1K (SERVICE -- BAR, ET <br />PHONE STAIEUCENSE� <br />HEATING SYSTEM: f 1 GAS fl ELECTRIC f l <br />CONiACT PERSON FNO PNONE NO <br />I HEREBY CERTIPY THAT I HAVE i?EAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />�ROVIS�ONS OF LAWS AND ORDINANCES GQVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WI7H WHETHER SPE(:IFIED HEREIN Ofl <br />NOT. THE GRANTIIJG OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTIO�d. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PGRFORM THE WORK FOR WHICH <br />APPLICATION IS iv1ADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1 27 RCW AND 296.200 `NAC. <br />X �.� ��- �n-��� <br />SIG iURE � � DFTE <br />CI7V 91151NE55 UCENS6110. � <br />MCI.I'1NIYIl.HI. <br />FEE NO. TYPE OF EQUIPMENT FEE <br />A/C — A/HN� LG UNITS — H.P. <br />. FURCED AIR SYSTEMS — 8: f.U. M E.A. <br />������8� <br />���G � <br />��(GS � <br />SUB <br />PER <br />TOTALFEE 5 <br />FOR OFFICE USE ONLY: <br />FRONT SETOACN RER(i SETDACK SICe SETpACK <br />USE20NE _ <br />❑EIGIIT LIMIIAI'ON <br />OCGUPANCV NO Of510NfS <br />GROUP <br />FIRE PLARb1 REO'� <br />Fl(7F. SPNINNLER REO'D <br />LOTRREA <br />NO OF OwLLLING <br />UN17S <br />RFASON <br />PLANSAPP� <br />oaTE i' <br />VAC�;NI SIiF <br />IIYES I1 NO <br />SIZE OF BLOGrtI <br />IIYES IiNO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PLAN f,11ECK NUMAER <br />FEES <br />OI/IL[11N ; <br />t'I UTAIt�NG <br />MfCH4NICAL <br />ADDI11pN�L PLRN CMF:CK <br />O1NER <br />iS — B.T.U. M <br />IYERS <br />IFAN <br />7 <br />ER <br />LACE(WOOD <br />JSERT(WO00 <br />CE <br />J � <br />� <br />i— <br />SUB TOTAL S —� <br />PERMIT 5 � <br />TOTALFEE S ' <br />FGF RECEIPiNO <br />VALUATION FEE <br />k.,;; , A I ; � <br />SiAI[ Ol11LDING SURf,HMCE <br />PIIflIIC YlOPHS <br />TOTAL <br />