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- ,�. <br /> APPLICATI�..�1 FOR CONSTRUC'► .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION �C���� <br /> 3200 CEDAR STREET•EVEFETT, WA 98201 •259•8810 <br /> C 1 DEMOLITION f-I CONIBINATION � BUILDIN(i Cl MECHANICAL f� PLUMBING I 1 SIGN <br /> PROJECT AODRESS � <br /> zo��i�■ Aaam� �vu-e�, w � 9�zo3 <br /> ONMER �aMt1ML�00RE5S �CI'V 21P PHONE <br /> t.t��l.lke✓ zo�I R ams _ rQu u!�"lv:-� .�'�;-Cfllolql <br /> TEtUNl MAIADGRE55 CI1Y ]IP PHpNE <br /> S v> l. `--� c11�'�Q , <br /> ARCMIlECTO SIGNEA MNL�DORESS QTY ZIP PNONE <br /> fYle�flYOQ� __L���2-'� <br /> NE�C�OR N.VLAWqE55 CITV ZIP PHONE ST11TElICENSE� <br /> �ackco�ara 1192b t�� 151 PL ��Il�ll 9�I I �IP,�r�uy� 1 ��CK�'�t,t /�T�/ <br /> MECHMNCALCONTRACT(M AWLqDDRESS CITY ZIP PN9NE STATEl10ENfiFY <br /> �ta �f�5i�',-� yg55-4471 <br /> VtUplING �CTOR MAIL RLY/qESS CITY 21P PHONE STAtE LICENSE Y <br /> TP EOF <br /> =1Q EATING SYSTEM: ❑GAS ELECTRIC ❑ <br /> OE RI E AND "FOOT�G IN OLJED CONTACT FERSON AND PMONE NO. <br /> ♦ � <br /> I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> - APPUCATION AND KNOW THE SAME TO BE TRUE ANC CORRECT.ALL i <br /> vrqrosE use oF euiioir�c ` ,/ PROVISIONS OF LAWS AND ORDINANCES GOVERNING TNIS TVPE OF <br /> � A �IFI� WORK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR <br /> -�l�E�°E ������ «+���'��TT��T��^°'�=' NOT. THE GRANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE �. <br /> �o�S -� e�pcKQ�U�'� pF�.JtN.ccr D�J �3_ At1THORITV TO VIOLATE OF CANCEL iHE PROVISION OF ANV � <br /> OTHER STATE OR LOCAL LAW REGULATING CONS7RUCTION OR THE ! <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHOfiIZED BV THE � <br /> OWNER OF THIS ROPERTY TO PERFORM THE WORK FOR WHICH �I <br /> �iISD- o�D- o1R - cC�L�O APPLICATIO MADE AND I COMPIV WITH THE STATE �,I <br /> PNICELTN(I.D.NUTABER CONTRA R� AW 182�RCW AND 296200 WAC. <br /> CONSiRUCT10N IOAN lENOER.AOORESS.TELEP110NE NUMBER x :/ -/ � �__ I <br /> 51 �TURE D�TE i <br /> � <br /> � CITV BUSINE55 LICENSE NO. <br /> pL11MBMiG MECMANICAL <br /> NO. TYPE OF FI%TURE OR RBi FEE NO. TYPE OF FIXTURE OR IiEM FEE <br /> WATER CLOSET(TOIIE� � A/C—AMNDLG UNITS—H.P. � II <br /> BATHTUB � FORCEDAIRSVSTEMS—B.T.U. M E.A. � <br /> UVATORV(WASH BASIN) i HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M <br /> KITCHEN SINK&DISP � CLOTHES�RVERS i � <br /> DISHWASHER VENTILATION FAN <br /> LAUNDRV TRAV � RAfv6E HOOD i � <br /> CLOTHES WP.SHER i WATER HEATER � <br /> URINAL WOOD STOVE <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKROW PREVENTERS i GAS FIREPIACE i . <br /> SINK(SERVICE—BAR,ETC.) � OAS RANGE � � <br /> ' OAS PiPING <br /> � EXHAUSTFAN � <br /> i <br /> i ' <br /> i ' <br /> SUB TOTAL f � SUB TOTAL S �, <br /> PERMIT $ PERMIT $ <br /> TOTALFEE S ' TOTALFEE S ' <br /> ROR OFFICE USE ONIV; � <br /> '"qq(f 5El9rCN RE�R SETB�CK � SIOE SETMCi( PIAN LHF.CK NUMBER FEE� I CEIPT NO <br /> Na�•. O � Zc� s �► lo W�• �6 �q�7 O � <br /> �sEzonE �oT�r� v,�c�rrrs�� ,�( FEES VAWATION FEE <br /> �./ O�' f]YES p ^� BUIl.OING (�1 2 � " <br /> I <br /> HEIOMfl1MT�TION NOOFOWELIIK�� SIZF��.OF6LIXVfl. . .. � <br /> Z p• UNITS ' � p�UMBING ' <br /> �� T'4 <br /> pCCIW�NCY p00F9tt)RIES OCCUPIwTLO/�t' B�SEMENT � �CH�MChI � <br /> . ' � � ❑YES I�NO � <br /> IIiXIM REO'U REASON �DO�T��MAI PLRN CHECK — � <br /> OTMER <br /> i <br /> FlRE BPiPNIlIPR REO'D AE�SOM � <br /> STFTE PURDMG SURCHApbE � i / <br /> rmEOFcoNp;r PIANS�rv,novGoev CRYOfEVERE'I�T ���++�s _ ' <br /> � LOCALSALEB <br /> �-l�__ o�,E 3 �iy � ?AX C61�UE.IS 3105 �7A� _�_ <br />