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APPLICAT14�1 FOR CONSTRUC? .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 • 259-8810 <br /> ❑ DEMOUTION fl COMBINATION fl BUILDING C7 MECHANICAL Il PLUMBING SIGN I <br /> PROJECT ADDRESS ' I <br /> 5��0 � E�a2.G�CFn� W�Y <br />� OWNER MAILADDRE55 QTY ZIP PHONE . <br /> F B�'e� ,+�a;b,�s �f�n� F.c-��� rvy �„��+, �,�z,�, zsF� s�� <br /> 7ENRNT MNLADORE55 CITY ZIP FHONE � <br /> 4 ARCHITEG?OROES�GNER MAILAOORE55 CIIY 71P 1`upNE <br /> �o,ecu� ,�� i�o:�� ,��.e,�o.� ,��t, �v, SND�2cur-C 9r�33 ss�z-.��j� SNv�eC-52/i¢�� ' <br /> GEK=RALCONiMGTOR MAILADDRE55 CIIY 71P pIIONL STATELICENSEt <br /> MECHANILAL WNTRACTOR MAIL ADDRESS CIN 71P PIIONE STATE�ICENSF.� <br /> PLUMBINGCONTRAf,TOR MAILAO�RESS CIN IIP PHpNE STATEI.ICENSEr <br /> CONTRAGT PRICE OF WOf1N <br /> � ScFSO, G�' HEATING SYSTEM: fl �^,AS f� ELECTRIC fl <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED CONTACT PF.PSON AND PHOHE NO. <br /> II _ INSTAr-[- iLLUMiNA7�-D PvcE SiGN vAJ yJnni /-trio�a�� S�fL- b�;37 — <br />'I C X/ST/�✓l, �O(�c' <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING APPLIGATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � �P�T'f7/L �/C% S.�($'� PROVISIONS OF LAWS AND ORDINAN(:ES GUVERNING THIS TYPE UF <br /> I WORK WILL BE COMPLIED WITH W':ETHEN SPECIFIED HEREIN OR <br /> LEGRLDESCRIPTIONOFPROPERTY�SHOWNBEIOWORATfACI1iWOCOPIES) NOT. THE GRAN7ING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> i tor e�ceK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOHIZED BY THE <br />�, OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> GARCELTA%I.D.NUMBER CONTRACTORS LAW 1027 RCW AND 296200 WAC. <br /> Syiq—DOO - C(� - ODZZ X�� /�� <br /> CONSTHUCTION LOPN LENDER,ADDRE55.TELEPHONE NUMBER �� .�.� F_i s ��.s <br /> Slfi�l RE �FiE <br /> �//C//�aL Qi:ltA�tOS <br />� CITY BUSINESS UCENSE NO. AA 1���7/y�� <br /> �. � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. 7YPE OF EDUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—AMNDLGUNRS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP i <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN S1NK 8 DISP i CLOTHES DRYERS i <br /> DISHVI�ASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD ; <br /> CLOTHES WASI�ER � WATER HEATER � <br /> � <br /> URINAL � WOOD STOVE ' <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN FIREPLACE�NSERT(WOOD BURNING) � <br /> � BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RAtJGE � <br /> ; GAS PIPING ; <br /> i EXHAUST FAN � <br /> � � <br /> � � <br /> , _—� <br /> SUB TOTAL S ; SUB TOTAL $ ; <br /> PERMIT $ i PERMIT S � <br /> TOTALFEE $ � TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRCNT SEiflACK r FEM SET�ACK SIDE SET9ACN PtAN CIIECK NUMO[� P[C: i1GCEIPT N0. <br /> s�.S � s.5 ' � o S 5��5 <br /> 115E 70L1E LOT FiiEA VPCANi 51IE FE VAIIIATION FEE <br /> -(�� f 1 YES N NO Ap��pMG L � <br /> HEIGIR UMITATI(�N NO.OF U'NELLING 512E OF 9LDC/TI � <br /> 6 VN175 /- PLUMOING � <br /> -- 'T <br /> OCWPANCY NO 0(51081E5 OCCUPANT LOAD BASEMENT � <br /> GROUP MEC11491CAL i <br /> IIYES II YO � � <br /> FIRE ALARM REO'D R[ASON MDI110'!�L PLnN G��f.GK . <br /> ---i_ <br /> i <br /> OiHER � <br /> FIRESPRINKLERRF.O-0 REASON <br /> STATE DOII�ING SUtiLMARGE � <br /> IYPEJFf,ONSi PIANS�P ROVF.�dV � <br /> �' CITY OF EVERETT ru�ur,wcaKs <br />� � Y� � LOCAL SALES ;�/l <br /> ����E � �, �_ �j ' TAX CODE IS 3105 TOTAL � U <br />