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APPLICATION FOR CONSTRUCT�JN PERMIT <br /> [:ITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> fl DEMOLIT1pN fl COMBINATION f l BUILDING f�7 MECHANICAI 'PLUMBING fl SIGN <br /> PROJECT ADDRESS r. / ,l <br /> er CaN. e� �S e �l� (��t't� � W�i . '� , / <br /> OWNER M�IL�OIX1E55 CIiY IIP PHONE <br /> ,�es48e7�1 Lew�s SA.�e 3 5'-0� v as�•73�iZ <br /> TEtUNJ) MML�DDRESS dTY ZIP FHONE <br /> /L <br /> .��/�J <br /> 11RC1tl�ECTOROES�GNER MI111�DDRE55 CITY ZIP PNONE <br /> GENERQCONTRAGTOR MAqADDRE55 �IfV ZIP PIIONE SiATEL�CENSE• <br /> MECNIINICALCONTR�CTOR M�IL�DORESS CITV zlP PNONE STATEUCENSE� <br /> sAm� <br /> VLUMlMGCONTR�CTOR M11L�DDPE55 CITY z�p PHONE STATELICENSE� <br /> CONTRI�Ci vRILE OF NqRI( <br /> HEATING SYSTEM: fl GAS (-I ELECTRIC fl <br /> OESCRIBE M/ORK AN�SW�RE F00TI1GE INVOWED CONT�CT FERSON�NO VHONE N0. <br /> Z <br /> I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> vn000seo use oF auadrac APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGIILDESCRIPTIONOFPqOPER7Y�51pWNBELOWOR�TTACHTWOCOPIE51 rypT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�opc ov AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAI LAW REOULATIN(i CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PNiCEL iNf IA.MIMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRV iION IO�N LENDEq,�DIX1E55.TELEP110Nc NUMBEN x �j�. �(� �j� �O/C� lyS <br /> SICa 111� E�—���� D�iE <br /> QTY BVSINES$UCENSE N0. <br /> PLIIMOIMO MECHANICAL <br /> NO. TYPE OF FlXTURE 0111TEM FEE NO. TYPE OF EWNPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—AMNOIOUNITS—H.P. ' <br /> BATHTUB ; FORCEO AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 6 DISP ; CLOTHES DRVERS � <br /> DISHWASHER � VENTIUTION FAN � <br /> UUNDRV TRAV � RANOE HOOD ; <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKINQ FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR ORAIN � FIREPUCE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIHEPUCE � <br /> SINK(SERVICE—BAR,ETC.) � OAS RANGE � <br /> ' OAS PIPINO ' <br /> i EXHAUST FAN � <br /> � � <br /> SUB TOTAL E ; SUB TOTAL S ' <br /> PERMIT S � PERMIT E � <br /> TOTAL FEE S � TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> iRpJT SEiA�LN REM SFTB�CN SIOE SETBACN PUN CIIECK NUMBER FEE AECEIPT N0. <br /> USE20NE LOTAREA V�C�Nf51TE FEES VALUATION FEE <br /> f1YES I7 NO BUIIOMG � <br /> _ i <br /> NEIGNTLIMITl1TION NO.OFOWELLIN6 92EOFBLOGRI <br /> UN175 PWMAING — __ i <br /> ROUP^NCV NO OiSfORiES OCCUPINTL0�0 BASEMENT MEGM�NIC�L � <br /> f1VE5 II NO � <br /> FIREI4ARMRE00 RF�SON /DD�IIONAI.M.ANCNf.CK � <br /> � <br /> OTNER i <br /> FIRF.SPPINKLERREO'0 REASON i <br /> ST�TE BUIIDMf.511RLNPfifiE � <br /> rvPeoFr,or�st rinNservroveoev CITYOFEVEi1E7T runur,wonKs ; <br /> LOCAI SALES -'— <br /> �„iE TAX CODE IS 3105 TOTAL <br />