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APPLICATI�►�I FOR CONSTRUC? �ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ;� DEMOLITION �l COMBINATION �l BUILDINr; �l MECHANICAL � 1 PLUMBING f 1 SIGN <br /> PROJECT ADDRESS <br /> 3/d 5 .�/�/� s��e��i .�=vc=�c.��q . <br /> OYMER MRILADDRESS CITY 21P PIIUNE <br /> ///DR7r�tuEsT �oo�..� a�o � yy�� �c« .st�,� �ao s�4,��. s�-��i C�� y�,�-�sso <br /> 7ENpNT MRII.p00Rf:55 f.IIY 71P � p1101:[ � <br /> �1oCc�,un��? .��N�US�^,rrJ �Lf12/,� �Ef�JTG c- �/QS �ii?Jr sr. �uc,eEiT <br /> ARCHITF.CTOROESIfNER MRIIROOPE55 CIiY )IP PIIONF <br /> CENERAL CONIfIPCTOR MRIIApDRE55 ([I1Y ZiP pIIONG SiATG LIC[NSE• <br /> MECHANICALCONTRI1C70R MAILRDDRF55 CITV 71P PIIONE STAiELICENSE� <br /> PLUMBINGCONIFACTOR MRILP�URESS CIIY ZIP PHONE STATEUCENSE� <br /> GUNiRACI FH!CE OF WORN -- <br /> ��a� OO U HEATING SYSTEM: I l GAS f 1 ELECTRIC f-1 <br /> DESCRIBE WORY ANO SOUARE FJJiAGE INVOLVED � T CT PERSON nND PIIONF.NO <br /> S IG,A/� K�v �(/ J��Uc S <br /> / - �OU - �� � ' 7�15i� <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSEDUSEOFBUILDING APPL�CATION AIJD KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHEH SPECIFIED HEREIN OR <br /> LEGALDESCRIPTIONOFPROPERTY�SHOWNPEIOWOHRTTRCH7WOCOPIES� NOT. THE GRAN7ING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> lOT_ BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTIIER STATE OR LOCAL LAW REG��ATING CONSTRUCTION OR THE <br /> PEFFORMANC[OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHIf.H <br /> APPLICATION IS MADE AND I COMPLY WITH THE STA7E <br /> PMCEL TNf I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTION IOAN LENOER.AOORE55.TEIEPHONE NUMIfER X I ��pv� (� �/�� ///O /� <br /> SIfNATURE OATE �—T <br /> QTY Bl15ME55 LICENS[N0. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILcT) � A/C—A/HNDLGUNITS—H.P. � <br /> � <br /> BATHTUB � FORCEDAIRSYSTEMS—B.T.U. M E.A. ; . <br /> LAVATORY(WASH BASIN) � HEAT PUMP <br /> SHOWER � UNITHEATERS—B.T.U. M <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS <br /> DISH�7ASHER ' � VENTILATION FAN � <br /> LAUNDRY TRAV ; FANGE HOOD ; <br /> CLOTHES WASHER � WATER HEATER <br /> URINAL � WOOD STOVE <br /> DRINKING FOUNTAIN � METAL F�REPLACE(WOOD BURNING) <br /> FLOOR ORAIN � FIREPLl.CE INSERT(WOOD BURNING) � <br /> BACKFLOWPREVENTE�iS ; GASFIREPLACE ; <br /> SINK(SERV�CE—BAR,ETC.) � GAS RANGE � <br /> � GAS PIPING ' <br /> � EXHAUST FAN � <br /> � � <br /> � � <br /> � <br /> � T <br /> SUB TOTAL S ' SUB TOTAL $ ; <br /> PERMIT 5 � PERMIT S � <br /> —�— <br /> TOTALFEE $ � TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> fRONTSFTPRCN REAfI$FTPACN SIDESETBAf.N Pl�NC11EC NUMpEP fFF �ECEIPTNO. <br /> � <br /> i <br /> usezoNe iornnen vncaHrsrte FEES VALUATION FEE <br /> rires r no � <br /> OUIl01NG �l L� � _ <br /> NEIGH7 LIMIi�TION NO OF DWELLING 52E O�BIDGRI i — <br /> IINIiS PIUAIp'9C i <br /> � <br /> OCGUP�NCY ND(`�StORIES OGCUPANT IOAD PASEMGNT � <br /> GROUP MFCR4NIGAL � <br /> 111[5 it NO � <br /> FIREALMMREOD RFASON ADO�110VM.PL�NGIF.CN //� i� ��- <br /> �_� �-.� <br /> OLIIER j <br /> FlRESpqINKLERREOD PE/.SpN i <br /> SINE OUIIDIHG SVtiC114RGE -- : ; l7� <br /> wJ!/ <br /> tvreorr,or+:r rinHsnrrnovFnnv CITYOFEVERETT runncwonKs � <br /> LOCAL SALES �— <br /> uaiE ,� �1 N TAX CODE IS 3105 TO7AL____ �75 ��J� <br />