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APPLICATIO"1 FOR COI�STRUCT'lN PERMIT�� <br /> CITY OF EVERETT• BUILDING DIVISION �%V�_ <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259•8810 ��Tr <br /> C7 DEMOLITION Ll COMBINATION ❑ BUILDIN(i I�MECHANICAL t� PLUMBING ❑ SIGN <br /> PROJECT ADDRESS Z'f b �� �E <br /> ' R 5 ��� �� Zhl��,�G Z�� E�r �i�vl �s 3r�� <br /> TE T M 111OIX1E5S iY 21P pHp� <br /> �eut� (,cx� T.�✓c Zl io I�rrr�vE Evr � -1�ry5 <br /> 11NCMTCCTORDESIGNER MNL�DORESS qTY IIP P1qNE <br /> a&NEMLCONTRACTOii MAILAOpiESS CITY ZIP PHONE STATEIJCENSE� <br /> � �ttE-�edr'�19�38 1�4'?�l�t�LJIE CvDuUc. `�v7L P�46��7 u� ���l�b <br /> PLUMlRqCpryTpACipp MiVL�WRE55 QTY ZIP PlIONE STATEIICENSE� <br /> � ��j��n HEATING SYSTEM: ❑GAS ❑ELECTRIC O <br /> �M'11r(� I1pSOU FOOTKSEMIVOLVED '� ^/ V. CONTACTPERSOAANUPNONENO. ' <br /> �/M4.. ��I <br /> S�i(y 144�F� I�crr B�-� <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAKiINED THIS . <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> r o use oF euaprxi PROVISIONS OF LAWS AND ORDINANCES GOVERNIN6 THIS TYPE OF <br /> �� WORK WILL BE COMPLIED WITH WHETHER SPECIflED HEREIN OR <br /> tFn��ocscpwraN oF ina+er+n� BELOW pi�TTACN TN9 CC°IES� NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br /> �pt e�pc�c pF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW RE6ULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WMICH � <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE � <br /> CO CTORS LAW 1827 RCW AND 298200 WAC. <br /> ��`iM'�8-oz3 -olo� � � 'r rZ-1 9b <br /> ca+smucna+�o�n�ermen.�oaness.��rHor+e�nw+ee+ x <br /> SIONATURE ^.� '� DATE <br /> �I� <br /> qTY BUSINESS IICENSE NO. <br /> PLUUSINO MECHANICAL <br /> NO. TYPE OF FlIfTURE OR ITEM FEE NO. TYPE OF FlXTURE OR ITEM FEE <br /> WATER CLOSET(TOILEI') � A/C—AMNDLO UNITS—H.P. � <br /> g�n{TUB ' FORC��AIFSYSTEMS—B.T.U. M F.A. ' <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> gMpWEp � UNIT HEATERS—B.T.U. M � <br /> KITCMEN SINK 6 DISP ; CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN + <br /> LAUNDRYiAAY ; RANGEHOOD ; � <br /> ' CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKIN6 FOUNTAI�I � METAL FlREPLACE(WOOD BURNINO) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNINO) � � <br /> BAq(FLOW PREVENTERS ; OAS FIREPLACE � � <br /> SINK(SERVICE—BAR,ETC.) � OAS RANf3E � <br /> ' QAS PIPINO ' � <br /> � E%HAUSt FAN � � <br /> � � � � <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL S ' SUB TOTAL S ' �. <br /> � <br /> PERMIT S � PERMIT S � <br /> TOTAL FEE S ' TOTAL FEE S � <br /> FOR OFFICE USE ONLY: <br /> FppN7$ETg11p( REAR SETBACK SIDE SETBACK PIAN CIIECN NUAIBER FEE PECEIPT NO. � <br /> J 7 ` ` <br /> USEZONE LOTAREA v�c�Nis�re FEES VALUATON FEE ; <br /> ❑�S n � BUILDINQ I . <br /> MEIONT IMTATON NO.OF DM'EWNC7 SIZE OF BL00/f I. i - <br /> UNITS p�UM8M0 � . . <br /> ��Y NO.OFSTqqES OCCUPNITLO/�D �ASEMENT MECHIJJIG1l . <br /> OYES ❑ � � <br /> FIREALARMREO'O RE�SQV AW�TONAIPIANCMECK i <br /> OTHER 1/101�— � <br /> FIRE SPR�M(�ER REQ'D REASON ���XV ' <br /> STATE BUtLORN3 NAROE <br /> iyPE OF CONST. PlANS D BY CITY OF EVERfiI'T PUBLIC WOIIKS i • <br /> � <br /> LOCAL SALES � <br /> DATE 1, . � 5 _5�( TAX CODE IS 7105 TOTAL � <br /> . i <br />