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:�._ ��.� / �A! .w�. /'i�..� <br /> /��,,�� APPLECATil .�1 FOR CONSTRUCti .ON PERMIT <br /> �' I CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STfiEET• EVERETT, WA 9d201 •259•8610 <br /> ❑ DEMOLITION f�l COMBINATION BUILDING fl MECiiANICAL f� PLUMBING fl SIGN <br /> PROJECT ADDRESS <br /> 3Go� L�rn �,:,�� v E�.� eN 9�d��� I z5 Z �Flo9 <br /> �°WNER MFILADDRE55 CITY ZiP PIIONE ' <br /> '\ly ' 1✓11Ya,v, // ��-/ /Z /'t.� Cv��eff� 9fiZul ZSb' 6 L� <br /> TENRNT n MAILADDRE55 GTV 71P t'HONE <br /> �� �/1 P/C �0 3�S15 /on f�� /��Yn�.��sV ;lC.i C7 �.Z7C7 Ci:J�� 3 �S Z <br /> ARGHITC�SIGNER NAILA�bPESS CITV 2�t' PHONE <br /> ���c a��.,. �v 6oX 7�1_ ,-,�a�ys�,: /<f �t�Z� u NRlLooiv� r�w <br /> �,/�EDIEflhLCO"1 PnGTOR MAILA�Oi1E55 GiY ZIP PNONE SIATELICENSE� <br /> I���-�, �; ��1e . t-aw �'v� C/F L.f cr s A �n5 3 93�— <br /> MECHANICAL COYTRRCTOR MI.IL ADORESS CITV ZIG PIIONE STATE LICEN _� � <br /> PLUMBINGCONTRACTOR MAILPODRE55 CIIY ZIP PHONE STATELIC6NSE� <br /> CONTRRCT ARICE 0�WORK <br /> J�� ,���� HEATING SYSTEM: I7 GAS f� ELECTRIC fl _ <br /> DESCRIBE WORN AN�SOUARE FOOTPGE INVOU`2G GONTACT PERSON AND PHONE NO. <br /> (a�. 1.6 n6�._� c.� ..aa • 'r c>n F C r (�S" 9 — <br /> �0.1 /3.c lc 4.c— <o S'9 3653 <br /> I 5 v F�-� <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAM�NED THIS <br /> APPLICArION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSED USE OF BUILDING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> ��,,,� �,,,L,w� WORK WILL BE COMPLIED WITH WHETNER SPECIFIED HEREIN OR <br /> LGALDESCRIPTICNOFPROPERTYISHOWNBELOWORATTACHTN'OCOPIES) NOT. THE GRANTING OF A PERMIT DUES NOT PRESUME TO GIVE <br /> �or BLOCK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULAT�NG CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI7ED BY THE <br /> "----' OWNER OF THIS PROPERTY TO��ORM THE WORK FOR WHICH <br /> AP LICATION IS MADE AND COMPLY WITH THE STATE <br /> P CELTA%ID.NOMBER NTRACTO�E"L� 18��RCAN D296.200WAC. <br /> � �; � � C <br /> /�"i7 3 8 J 9 c90( v' o � �r � LZ-�/— 2 f 9s' <br /> CONSTAUCTION LOAN LENDER,ADUAE55.TELEPMO4E NIIMDER X /H I <br /> 51 ATIIRE D�TE <br /> A� h�G — <br /> CITV BUSINESS LICENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C–A/HNDLG UNITS–H.P. ' <br /> BATHTUB ; FORCEDAIRSYSTEMS–B.T.U. M E.A. ; <br /> LAVATORY(WASH BASINj � HEAT PUMP ' <br /> SHOWER � UNITHEATERS–B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY 7RAY ' RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER ' <br /> � WOOD STOVE � <br /> URINAL � <br /> DRINKING FOU`ITAIN � METAL FIREPLACE(WOOD BURNING) � <br /> ' i � FIREPLACE INSERT(WOO�BURNING) ' <br /> FLOOR DRAIN � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE–BAR.ETC.) __ GAS RANGE ' <br /> GAS PIPING � <br /> � <br /> ; EXHAUST FAN ' <br /> _ i <br /> - � � <br /> _ —�-- � <br /> SUB TOTAL $ � SUB TOTAL $ i <br /> PERMIT S i _ PERAIVT L ___�_ <br /> TOTAL FFE $ --' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: -- � <br /> �I�[SETBACK PLANCNF.CNNUMAEfi FEE ���G RECEIPTNO. <br /> FRONTSETBACN REARSETAACK • , <br /> a � � VALUATION FEE <br /> USE 20'!E 2 LOTA�(1E"A V�CANT SRE FEES //j <br /> �'' �y �6 �U f lYES /n N� DUILDING �U S D� / /��f ' <br /> _f_�v� <br /> HEIGNTUMITATION NOOF�WELIJNG SIZEOF9lOGR1. � <br /> UNITS � 1 �l PWMOING <br /> 10 I <br /> OCCUPANCV N�0�STOf1.f e OCCUPANT LOAD 9ASEMENT MECIIRNICAL ! <br /> G!i UP � � <br /> R ,� ` 1 ❑V[5 NO qODITONRLPLANCHECK � <br /> 1) <br /> FIREAIARA'REO'0 RERSON —� <br /> � OTHER � <br /> v <br /> FIPESPRINY,LERAE00 REASON � <br /> STAlE9O1L01NG5UPLMARGE � � � <br /> N � ' <br /> TVPEOFCONST. PIANSAPPfjOVEDBY CITYOFEVERETT ruo�icwonKs —� <br /> J_ , / ,�;� LOCAL SALES D �� <br /> " TA%CODE IS 3105 TOTAL <br /> ' DAIE � -� <br />