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APPLICAT14�+1 FOR CONSTRUC? �ON PERgVI1T/ <br /> CITY OF EVERETT• BUILDING DIVISION VCAr✓� <br /> 3200 CEDAR STREET•EVERETT, WA 982�1 •259•8810 � <br /> �l DEMOUTION fl COMBINATION pd BUILDING fl MECHANICAL f� PLUMBING fl SIGN <br /> PHOJECT ADDRESS � <br /> 01YaEP M�n A�Ot1E55 CITv 'IP pIqNE <br /> �'�Idmc.rk- ��Je.r,�.�ses Ris�;ic� r�d Lake,�l�c�,s 33�E- qc,s�� <br /> TENIINi MA�AC�XI.SS CITV 7iP PIIONC: <br /> /� / <br /> � ��,��� <br /> •RCNITECTORDESIONER MNlA0DRE55 [IfY )iP PNONE <br /> OENERAI.CONiR�GIOtI MAIL�[10fiE5S (;IiY IIP p110NE STIIIEUCENSE� <br /> ��o(drn a.r k F-»-l��Y1�s G�,.5�; fc� ('d.LakaS�werb 9�tsb 33�-� �(,�-t� <br /> MECII�NIC�I CONTR�CTOR M�Il11D��E55 f,ltt )IP PIIONE STATE LICENSE/ <br /> Goldr►�z*o9�R.p <br /> PIUMBINOCONTR�CTOq MAI��pp11E55 CIIV ZIP p�IpNE ST�TGIICENSE� <br /> Sq, UOb � W <br /> GONTRACT PRICE OF WORK ---- <br /> ,a�5"i-� [9 �{- '�1t� � Q HEAT�NG :YSTEM: GAS f] ELECTRIC ❑ <br /> OESCRIflE YAPM�ND SOU�RE FOOTFOE INVOIVI[�� CONT�Ci VFfiSON�ND P NO <br /> r� � o �.Pl.v1'�n2. �-�ran�-}�rm'� <br /> �i o a3g - oe�'�� <br /> ��,�,���� I IIEREBV CEHTIFV THAT I HAVE R�AD AND E%AMINED THIS <br /> PROPOSED USF.OF BL'1lDIN0 APPLICF.i 10�!AND KNOW THE SAME TO!!E TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS T1'PE OF <br /> � WORK WILL BE COMPLIED WITH WHETHER Sf'ECIFIEO HEREIN OR <br /> teauoesCjilPTlplOFPlIOPERTY�SM(MMBE.OWIXi� c��ies NOL THE ORANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br /> t0T O—� BiocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHEH STATE OR LCCAL LAW REOUTATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 A.'.�AUTHORIZFD BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH . <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCELLVIIO.NUMBER CONTRACTORS LAW 1827 RCW AND 286.200 WAC. <br /> / q <br /> CON UCTION.LO-�1N,LEN�EII.AO RfS5.7ELFPNONENUMBER A��J_��^,/�� / 3� q5 <br /> Vl�[.(J A.V � U �SF�iN�iURE DQE <br /> CIIY BUSMESS LICENSE N0. <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FUfTIIRE Oq ITEM FEE N0. TYPE OF FI%TURE OR ITEM FEE <br /> �p WATER CIOSET(TOILET) � A/C—A/HNOLO UNITS—H.P. i <br /> BATHTUB ' 'J-- FORCED OiR SYSTEMS—B.T.U. M E.A. ' <br /> IAVATORV(WASH BASIN) � <br /> i HEAT PUMP �— <br /> .— <br /> `JHOWER � UNITHEATEFlS—B.T.U. M � <br /> �— KITCHEN SINK 8 DISP ; CIOTHES DRYERS ' <br /> i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDFY TRAY ; RAN(�E HOOD ' <br /> � <br /> � CLOTHES WASHER i W�,TER HEATEF � <br /> URINAL � WOOD STOVE � <br /> DPINKING FC'�11NTAIN i METAL FIREPLACE(WOOD BURNING� i <br /> FLOOR DHAIN � FIREPLACE INSERT(WOOD BURNING) —�— <br /> BACKFLOW PREVENTERS � OAS FIPEPLACE ' <br /> _ _ _ , <br /> SINK '�ERVICE—BAR,ETC.) � OAS RANOE <br /> ' OAS PIPINO � <br /> � E)(HAUST FAN � <br /> � <br /> i � <br /> � — ; <br /> � � <br /> � � <br /> SUB TOTAL S � ' SUB TOTAL f ; <br /> ?EHMIT E i � PERMIT E i <br /> TOTALFEE E � TOTALFEE S )' <br /> FOR OFFICE USe ONLY: <br /> FRONT SETBACR 11EAp cF.TP�CN SIDF.SE�LN� P�AN�HECR NIIMBER FEE ,� � AECEInT N0. <br /> �LO� � .(. ��.�.�D U <br /> y-»�.� � � � <br /> use zor+e ior�ne� veu+r sre FEES VAIUATION FEE <br /> — 'SZ�'/ 7 �es n r�o <br /> PUIIDINo � —� � �-' 'i <br /> 11EtONT UMli��l J � 110 OF OWELLINO SIZE OF Bli OR <br /> UNitS 7�y ;� �vi��4 � — <br /> 6 � � rwumr+o �: , <br /> OCCUP�NCY ND O�SIIX11E5 OLCUP�NTIO�D B�SEMENI � <br /> GR P� Z � � MECN�NIC�L <br /> ❑vE9 fl NO <br /> i _ <br /> FlRE�IMM PFO'0 I1E�SON <br /> A�D1110N�lM�NCHECI( '� —� � <br /> Oi11ER � �: . �C'� <br /> FIRE SPPINNIEB REO'0 RE�SON <br /> STRE BUIIDIN(i SURCH�ppE -� !,/ �J <br /> /' /l <br /> rvne ov coNsr P�ANS�PPROVEO PY CITY OF EVEAETT runi.�c won.s '� 'I <br /> \I/� LOCALSALES l l�� <br /> �"�� o•*e 7 y"$ TAX CODE IS 3105 TOTAL ����j� j — <br />