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APPLICATION FOR CONSTRlJCT10N PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> fl DEMOLITION fl COMBINATION fl BUILDING MECHANICAL �1 PLUMBING fl SIGN <br /> PROJECT ADDRESS <br /> C1�� � - � <br /> �I�E��� ''� MP�r1pORE� ,� I��� � 21P PH�N[ <br /> ���-�-� � � <br /> TENANT MpILApDR SS CITY ZIP PIIONE <br /> �,� — �� �o ����,�r��'���1 �1,�� �J��1- R�v�� ���-- (� T� <br /> �RCMITF.CTORDESIGNER MAl1.A0DPE55 Gltt Z� PNON[ <br /> �sr w� t�y��t. � <br /> GE��DIKE AYEAAL� ��rY ���' P110NE SIAiELICENSE� <br /> �-.rnc � mtOY ��7..����� al���c�f��v>�� <br /> MEl�lA11 A T 0 AILpDDRE55 Cltt 21P PIIONE STATEUCr.NSE� <br /> PLUMBINGCON7R�CTOP MRILADDRE55 ���t ZIP PHONE STATEUCENSE� <br /> CONTRAGTPRICEOFWORI(�L �� • <br /> ({� -� HEATING SYSTEM: GAS �i ELECTRIC f-1 <br /> DESCRIBE WORK AN�SOUr1RE FOOT�GE INVOIVED �ONTACT PFRSO�AN� 110N N � /� <br /> t� � ' <br /> (,�}� CE � '_ <br /> i HEREBY CERTIFY THAT I HAVE READ AND E%AM�NED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT AlL <br /> PROI'OSED VSE OF BUILDING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL �E COMPLIED WITH WHETHER SPECIFIEO HERE�N OR � <br /> LEG�LDESGR�PTIONOFPROPERiV�SNOWNBELO\VIXiRTTACHTWOCOPIES� NOT. THE GFANTING OF A PERMIT DGES NOT PRESUME 70 GIVE <br /> ior e�ocK or_ AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROP TO PERFORM THE WORK FOR WHICH <br /> APPLICATION I ADE AND COMPLV WITH THE STATE <br /> PMCELTAXI.D.NUMBER � CONTRACTO AW1B.27 OOWAC. <br /> CONSTRUCTIONIO�NLENOER.ADDRE55.TElEPMONENUMBEA X ` / � / <br /> SIGN�7 RE DA G <br /> CITY BUSINES$LIGENSL NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fll(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILEn � A/C—A/HNDLGUNRS—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. �_ <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNORY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN FIREPLACE INSEFT(WOOD BURNING) ' <br /> BACKFLOW PREVENTEflS i GAS FIREPLACE i <br /> SINN(SERVICE—BAR.ETC.) � GAS RANGE ! <br /> � ' GAS PIPING � <br /> � EXHAUSTFAN � <br /> i ' <br /> SUB TOTAL 5 ' SUB TOTAL 5 � <br /> PERIAIT 5 � PERMIT S <br /> TOTALFEE 5 � • TOTALFEE 5 ' <br /> FOR OFFICE USE ONLY: <br /> FAONTSETIIALN REpRSETBRCR SIDESFTBRCN �L6NCIIECNNUMOER FEF RF.CFIPTNO <br /> usezoNe �otnaea vntnrvt5ire FEES VALUATION FEE <br /> t I YES f 1 NO ppILDIqG <br /> HEIGIITLIMITRTION NOOFOWELLING SIZEOFBLDGRI � <br /> UNII$ PLUTAOING <br /> � <br /> OGGUPANCY NO(KSfONES OCCUPANiLOAO BASEMENi MfC�InNILnL i <br /> GROUP <br /> IIYES Ii NO <br /> FIREAURMPEOD RF�SON A�OpION�LPL��lCMFCN � <br /> �— <br /> OiMER i <br /> FIRF SPf11NKlER REOD RFASON <br /> $TNE DUILOING SURCIIPRC.E <br /> �"_� <br /> rvreoFr,or+st ainNsaornoveoov CITYOFEVERETT rueiir.vror�Ks <br /> LOCALSALES -- — <br /> unre TAX CODE IS 3105 TOTAL �_ <br />