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APPLICATIOI. FOR CONSTRUCTI�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> (-7 DEMOLITION ❑ COMBINATION ❑ BUILDING !Gf MECHANICAL fl PLUMBING I-7 SIGN <br /> PROJECT ADDRESS � <br /> �9�� P��,��, � <br /> ONTlEfl MML MDNESS CITY ZIP PNON[ <br /> Qe1� Qco„+w "IHx3 �a� s�. S.t Lvvr�"� 98�oS 334- '1`139 <br /> TENANT MAILADDRE55 Cltt ZIP VHONE <br /> ARCMITCGTORDESIGNER MAILI�DOAE55 CITY 21P PMONE <br /> GENERALCANTRALTOR MNLA�ORE55 CITY ZIP PMpNE SiREl1GEN5E� <br /> MECNANICALCONTR�CTOR M�I�ADDRE55 CITY ZIV PNONL STQEULENSE� <br /> _L'.v,ror��� 5�.,'� 5/r, Po . (Sox Ifof rrt,e� 9?xu(, zsz-��iH E✓�-+t�s-Si.tiJc7 <br /> FLUM G CONTRALTC%i �ILADDRESS CITY 21P PMONE STATE LICENSE� <br /> CONTRACIPRICE OF WOfiK <br /> �� o a HEATING SYSTEM: ❑ GAS ❑ELECTRIC ❑ _ <br /> DESCRIBE WIX1K AND SOUARE FOOTAGE INVOLVED GONT�Ci PERSON 11ND VNONE N0. <br /> {.p 71 .a rn4fr � a `RCa � <br /> w'� Un�, 'Y r A�R t5 Q Y <br /> S L\ P� I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> T APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> vaovos use oF euaon+c PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> O�,\ s SOa�E WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRIPTIONOFPROP TV�SMOWNBELOWIX7ATTACNTWOCAPIES� NOL THE GRANTING OF A PERMIT DOES NOT PHESUME TO ('iIVE <br /> �ot e�ocK o� AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW qEGULATING CONSTRUCTION OR THE <br /> PEFFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF TMIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPL�CATION IS MADE AND I COMPLY WITH TME STATE <br /> PARCEL TAR ID.NUMBER CONTRACTORS/LA�W 1827 RCW AND 286.200 WAC. <br /> CANSTi1UCTON IOAN LENDER.�OIXiE55,TELEPNONE NUMBER X ,]�-C b ���a p !2-2 9. 9 y <br /> SIGNAiU D�TE <br /> CITV BUSINESS UCENSE N0. <br /> PLUMBIN6 MECHANICAL <br /> N0. TYPE OF FU(TURE OR ITEM FEE N0. TYPE OF FU(TURE OR ITEM FEE <br /> WATER CLO5ET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; I FORCED AIR SYSTEMS—B.T.U. a�M E.A. <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN S�NK 8 DISP � CLOTHES DRYERS <br /> DISHWASHER � VENTILATION FAN � <br /> IAUNDRY TRAY ; RANGE HOOG i <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BUHNING) � <br /> �— <br /> FLOOR DRAIN � FIREPLACE��'SERT(WOOD BURNING) y_ <br /> BACKFLOW PREVENTERS ; GAS FiREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE <br /> ' � GAS PIPING <br /> i EXHAUST FAN � <br /> � ' <br /> � ' <br /> � <br /> SUB TOTAL 8 ; SUB TOTAL E ; <br /> PERMIT S � PERMIT S � <br /> TOTALFEE $ ' TOTALFEE S � ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SE18�CN RE�R SEiBACK SIOE SETB/�CK PUN CNE N NU FEE RECEIPf NO. <br /> ��5� <br /> u5ezor+E to7nREA �AC�NTSIiE FEES VALUATION FEE <br /> �— <br /> � <br /> nves n wo �ui�oiNc ; <br /> MEIGHi'�MITATION NOOFDWEWNG 5490FBLDG/fl. � <br /> UNITS p�UMBING � <br /> OCIXIPANCY NO Of 57IXUi5 OCCUPANT LORD BRSEMENT MECHANI'AL � <br /> GROUP V <br /> ❑VES ❑NO i <br /> FIRC�URM REO'D i1EAf'�ON ADDITION�1 PUN CH[CK � <br /> � <br /> OTMEH <br /> FIPESPRINKLERPEO'0 REASON i <br /> STATE B7IlDING SURCNGRGE � <br /> �YPEOFCANST. PUNSMC50VEDPV CITYOFEVERE7T PUBLICWORKS � <br /> LOCAL SALES ; — <br /> ��,-� TAX CODE 1S 31b5 TOTAL ' <br />