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APPLICATIOrI FOR Ct7NSTRUCTrON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 • 259•8810 <br /> f-1 DEMOLITION f 1 COMBINATION f1 BUILDING I� MECHANICAL i 1 PLUMBING f 1 SIGN <br /> PROJECT ADDRESS �� ������ ��� <br /> owrvE�a M/RAOOfiF55 cm nr PIIONE <br /> �,�h,-FcQST 31b�1� ` lobl �/�- iW� f�iiZ/(o Y-/ W� �BIZ� <br /> TENRNT M�ILADOPF55 C17Y IIP p110NE � <br /> �� i� ia � h �. . <br /> ARGIIRF.GTO�i�E51GN[i1 MAII.ADDRE55 CIPI 71P PIIONF <br /> NO�-cc <br /> GENEIIPLCOYIP�Li07 MnILAO[1PG55 CIIV IIP PIIONE SiAiL110EN5E• <br /> ntuN� <br /> MECI NICA��pNTRACTO� MRiLADDPF.55 f.ITV ZI{` PIIONE SiAtELICF.NSE• <br /> Srt.Yu.� �� ��eL�« �,saw.rs gso3 �saN� a..�d ►.\. f . k�0.�+A 98a52 Srv2�cDo�7NU <br /> PIIIMOINGCONIRAf,iOR MAILR��PE55 � _ Gltt —` 21P PIIONE Si�iEUCENSE• <br /> wv <br /> coNrnecr Pnic6 or wonK <br /> �;� EATING SYSTEM: f I GAS �l ELECTRIC f l <br /> DESCRIOF.WORN AND SOUAFE�JC TAGE INVOLVED CONT�CL PFRSON�N�P110Nf 1�0 <br /> �vl+fR-ri u P�2 J nli� . St-tn� �nl 1. Ilv� nl� nl 6 <br /> I�5-rn�.� � 5 6�1 S�S'^ o8�-(Z <br /> Q�{� G� '{ U 6�-F-r-S I HEREBV CEFTIFY THAT I HAVE READ AND EXA1dINED THIS <br /> APPLICATION AND KNOW THF SAME TO BE TRUE AND CORFECT ALL <br /> vnorosEo use oF nuaov�c PROVISIONS OF LAWS AND OFDINANCES GnVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHEI; SPECIFIED HEREIN OR <br /> LEG�LDESCRIPTIONOFPROPERTVISIqWNBELOWORRTipCHTWOCO�'�ES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior e�a;K or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LA.V REGULATING CONSTRUCTION OR THic <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY TH'_ � <br /> OWNER OF THIS PROPERTY TO PERrORM THE WOFK FOR LYHICIi <br /> APPLICATI N IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%ID.NUMBER CONT C PS LA 7027�i1j W AN 296.200 WAC. <br /> LONSTRUCTIONIOANLEN�ER.�DORE55.TElEPNONENUMBEp X r �(/J/� '� �-� �p <br /> $IGN UR" On1E _Y <br /> � QTY BUSINE55 LIC[NSC NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> _ �— <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR Sl'STEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEA7ERS—B.T.U. M I <br /> KITCHEN BINK 8 DISP � CLOTHES�RVERS � ' <br /> DISNWASHER VENTILATION FAN � <br /> LAUNDRY TRAY � RANGE HOOD ' <br /> —i— <br /> CIOTHES WASHER � WA1 ER HFATER <br /> URINAL WOOD STOVE <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BUFiNING) � <br /> FLOOF DFAIN � FIREPLACE INSERT(WOOD BUFNING) � <br /> BACKFLOW PFEVENTEFiS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE � <br /> ' GAS PIPING ' <br /> ; EXHAUST FAN � <br /> ; _ � <br /> SUB TOTAL 5 ; SUO TOTAL 5 ; <br /> PERMIT 5 � PERMIT 5 � <br /> TOTAL FEE 5 � TOTAL FEE 5 �_ <br /> FOR OFFICE USE ONLY: <br /> fPONTSFTpRCN RC��SFT��CK SIDESET[fa�N PIFNCnECNNUMOFR �EF /a REf.FIPt40 <br /> i <br /> 7� i� ! C'� �� � , <br /> usczoNe yfNeae VPCpNt5lif FEES VALUATION FEE <br /> �J T— <br /> C _ � p- Z� y� t i YES �� OUIt�n1G � <br /> IP illi LIMI711TION q0 OF�YI[UING SIIE OF OIDGRI � <br /> I1NII$ � PlUMO�NG � <br /> L1� — � <br /> p L9PANCV NO Ot SIOui[5 OGCUPANT LOAO BASEMENT MF�'�',���C)L � <br /> csnyr -- <br /> IIYFS ii NO <br /> fIREALARMRE01` PFpSON AD011.JNA�I+L�NCNF.CN _ <br /> � <br /> O711E� � <br /> FlI1FG�'�INNlERf1EOD �iF4SON i <br /> STAIElfUR01NG5Uf1CMRPGE — �_!'S,�,: <br /> v_<._ <br /> iv�eorcoNsr rinNsnrlvpoveonr CITYOFEVkSRETT runucwonKs ; ' <br /> �jM LOCAL SAIES - ��— . <br /> _ �,,,rF. Q� g TAX CODE IS 3105 707AL___ _ _ �� � ' <br /> _ __ _—l�—b—C_ <br />