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APPLICATION FOR CONSTRUC7 .ON PERMIT <br /> 11 )Icy CITY OF EVERETT• BUILDING DIVISION <br /> ll jqfC1U,,(_ 3200 CEDAR STREET • EVERETT, WA 98201 • 259.8810 <br /> 11 DEMOLITION XCOMBINATION I I BUILDING I MECHANICAL 11 PLUMBING I I SIGN <br /> PROJECT ADDRESS <br /> n }"' -i w r � 1 /aiq 114 <br /> OWNrn MAIL ADDRESS City 1 IIP PHONE <br /> ��C1S-ttL�l1, Uj(1 ggol;1 (2A 3i -6,)101 <br /> 1FIUNf "ALL ADDRESS CITY IIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY 71P PHONE <br /> 7F�S15►Lf�y$cch;_lcs y0 A1uN At er �S„i�� na r�E,ucLN A c1matc, <br /> GENERAL CONRIACTOn MA',ADDRESS CII SIP PHONE STATE LICENSE I <br /> Metw ldomes L10- SflMC1" Q_ <br /> TC.pay <br /> MECHANICAL CONTRACTOR MAIL ADOIIESS CITY IIP PHONE STATE IICCNSE I <br /> WCA-z lurnhuis ���4 jp�i4ti St JerP4� jh gs )AR eQn(,)�3-Ig. IUs -1 WALTSPIS6RP <br /> PLUMBING CONTRACTOR MAIL ADDRESS City ZIP PNONNEE� STATE I ICENSEI <br /> CONI T PRICE Or WIAfK ' <br /> -Sill ' ILGIETLAW-LAS <br /> HEATING SYSTEM: XOAS 11 ELECTRIC I I <br /> 1)ESE.NIBE WORM Arm SaMnE raoTAOE)Nva VED C TA CT PERSONAND rI rN0 A <br /> •• �' L C a y or 41'1�KP IIALt'yz 16f <br /> St Ad — a <br /> yzasemQ tJf 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> rR01'OSED USE OF BI111101NO PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> - P""D, 1110 � �tti5\G �4Q WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAL DESCRIPTION Or PROPERTY(SNOWN BELOW OR ATTACH TWO COPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT FV1 BLOCK Cr - AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER 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 /> VO4uMe C �T-09 t'ICT+�, APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> PARCEL TAXI O NUMBER -' I CONTRACTORS LAW 1827ACCWAND 296.200 WAC. <br /> CONSiRUC RON IOAN IENDER.ADDRESS.TEL EPIIONE MIMBEn //)) <br /> Y�/.T(d/N //Il/ lY�.�' Ia, <br /> S NANmE � DATE <br /> CITY BUSINESS 1 ICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM _ FEE NO. _TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) I A/C-AIHNDLG UNITS-H.P. <br /> BATHTUB ' FORCED AIR SYSTEMS-B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) _ I HEAT PUMP , <br /> 1 SHOWER ' UNIT HEATERS-B.T.U. M ' <br /> KITCHEN SINK 8 DISP CLOTHES DRYERS <br /> DISHWASHER I VENTILATION FAN I <br /> LAUNDRY TRAY ' RANGEHOOD <br /> CLOTHES WASHER , WATER HEATER <br /> URINAL _ ' WOOD STOVE <br /> DRINKING FOUNTAIN , METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN , FIREPLACE INSERT(WOOD BURNING) r <br /> _BACKFLOW PREVENTERS GAS FIREPLACE ; <br /> SINK(SERVICE—BAR.ETC.) GAS RANGE <br /> GAS PIPING ' <br /> EXHAUST FAN , <br /> , I <br /> I <br /> SUBTOTAL S ' SUBTOTAL S ; <br /> PERMIT S 1 PERMIT S , <br /> _ TOTAL FEE S ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> r oNTSF11RACK PUGSFTDACK ;ANF SrlGefe PIANCIIFP.K NIIIAnFn PIT RECEIPT NO <br /> USE ZONE Lor AMA VACMU sur FEES VALUATION FEE <br /> I IYES 11 NO DIMMING <br /> 1 IEIGIIT IMITATION NO or DWrILING SITE Or BI Ran 5 O <br /> UNIIs 29'tu 3 F.GAI + t� <br /> rnlMnnm �J � <br /> OCCUPATICV IAT(N STPn15 OCCUPANT LOAD BASEMENT MECHANICAL �0 <br /> Gnam <br /> �'3ILY I�2 InB3 II/rm - <br /> FIREALARMREOG REASON AIXXRONA1 VIANCNECK <br /> RULE" <br /> rIRE srnINm EnnEoO RFASOI <br /> STAIEBIL11DI1rns11nCL1AnnE <br /> TYPE OF CONST PI ANS APPROVED BY CITY OF EVERETT )VRI K.wnnK% LSL <br /> -ilk LOCAL SALES --- - <br /> OATE 123 TAX CODE IS 3105 TOTAL_ __ <br />