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APPLICATIG�1 FOR CONSTRUC7 �ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOLITION f 1 COMBINATION �) BUILDING fT.MECHANICAL �l PLUMBING f 1 SIGN <br /> PROJECT ADDRESS C„ _ � � <br /> a9a� ,o.�,G.�� <br /> ����in�� n M�IL AD�f1E5.5 �n, <br /> w (�'/`/� z� PNONE <br /> TENRNT MAII p F55 <br /> �/n '' ' n �� CITY ZIP PIqNE <br /> V� (Nt/l� <br /> FpC41TfGT OR pE51GNER MAIi.ADpRE55 ��n, <br /> ZIP PMONE <br /> GENCRAtCONfMCiOq MAI�ADORE55 CIiY <br /> ZIP PHON[ c1AiE LICCNSE• <br /> MFCHRNI�q�CONTRA�lOR MAIL pODf1E55 CITY 21P PIIpNE STATE UGENSE� <br /> �1�ii-. lnic ,�0;�1'7- �'ro�2 I,o�cx� 2r� LYAINu,e r� 44���� ?r 3597 ER�cr<� aia�7 <br /> PiUM61NQCONTRRfTOR N41L�DDpE55 ��n. <br /> IIP P��n4F c�erF��rFNcE. <br /> corvra�cT cr+y�pr�yprpc� <br /> 6U ��� HEATING SYSTEM: f 1 GAS "1 ElEC74aIC fl <br /> OFSCRIBE WOPK p p SpUARE fOOTnGE INVOLVEO CONI�CT PEHSON hNp PHONF NO <br /> � .� o(s '- T <br /> _l �� � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> raoroseou QoFeunoir+c APPUCATION AND KNOW TNE SAME TO BE TRUE AND CORRECT ALL <br /> (((Q,kJ�¢/�i PROVISIONS OF�AYJS AND URDINANCES GOVERNING THIS TYPE OF <br /> LEG�LOESGRIPfIONpFpqOP �SHOWNBELOWOP�TTACHTWpC01'IES� H'ORK WILL OE COMPUED WITH WHETHER SPECIFIFD HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DDES NOT PRESUME TO GIVE <br /> 1OT —eLOCK oF— AUTHORITY TO VIOLATE OP. CANCPL THE PROVISION OF ANV <br /> OTHEfi STATE OR LOCAL LAW FEGULAI ING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.TIi 4T I AM AUTHORIZED BY THE <br /> OWNEFi OF THIS PROPERTY TO PERFC�RM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> P�RCELTNlID.NIIMBER CON"fFACTORSLAWIB.? CWAND".d6.200WAC. <br /> CONSTFUC710NlOANLENOER,nODpE55.TE1E1'NONENUMBER / � � , //_a� ��/ <br /> x � J <br /> si. in oaTe - <br /> CI7Y BUVNE55 LICENSE NO <br /> PLUMBIN6 MECHANICAL -- <br /> NO. TVPE OF rll(TURE OR IT�M FEE NO. TYPE OF EOJIPMENT FEE <br /> WATERCLOSET�TOILET) � A/C—AMNDLGUNITS—H.P. �— <br /> BATHTUB ' FOFCEDAIR3YSTEMS—B.T.U. M FA. � <br /> i <br /> LAVATORY(WASH BASIN) i HEAT PUMP <br /> � <br /> SHOWER _ � UNITHEATERS—B.T.U. M �`- '� <br /> KITCHEN SINK 8 DISP i CLOTHES DRVERS <br /> DISHWASHER ' <br /> ' VENTILATION FAN --T— <br /> LAUNDRY TRAV � RANGE HOOD � <br /> CLOTHES WASHER WATER HEATER � <br /> URINAL ' <br /> � WOODSTOVE � <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD DURNING) � <br /> BACNFLOW PREVENiERS � GAS FIREPLACE � <br /> SINN(SERVICE—BAR,ETC.) , ' <br /> GAS RAF7GE � <br /> — ' GAS PIP�NG i <br /> � EXHAUSTFAN � <br /> i � <br /> � — <br /> i � <br /> ' <br /> SUB TOTAL $ � SU8 TOTAL $ � <br /> PERMIT $ � PERMIT $ � <br /> TOTAI FEE $ � TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> fRONT SFTPRCN qE�R SF.TB4CN SIDE SETBnCK i'LAN C11[CK NUMOFR F[F PFCFt`T NO. <br /> ,�D/On <br /> UFE ZONE ioi naen VACANi sire FEES VALUATION FEE <br /> I I yES �� N� BUILpMA � <br /> � <br /> HfIGNT LIMIiRTlpll Nt, pt OWELLING SIZE OF BLOG41 � <br /> lMqS � <br /> Pi VIdPING � <br /> OCGUPONCY NO Otc�OqqS OCCUPqM IOAC BRSEMENT � - <br /> GilOU�' ldEGInNICAL � ` <br /> f1YE5 �1N0 � __" <br /> fIqER��M�[OP BfR50Y ADD""1N�I.PLANCNF.CK i <br /> ..� � <br /> OiNEN <br /> FlRFSPPINqERREO�� NERFOY <br /> ciAlE 9U�1 DIN(i cURLNARGE _—' � -- <br /> lY(`F OI CONST PIAN511PPM' S(1 BY --- — --��"— <br /> ��„ CITY OF EVERETT ru�ur wn��c <br /> ��� LOCAL SALES — <br /> .__ na.E �'�^ ,- ' TAX CODE IS 3105 TOTAL <br /> -- —-- --- ----`---�— <br />