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APPLtCAT10A FOR CONISTRUCT�ON PER�IAIT�w��� <br /> CITV OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •2'i9-8810 <br /> I l OEMOUTION I i COMBINATION I i BUILDING i I MECHANICAL i ' PLUM8ING SIGN <br /> PRWECT ADDRESS <br /> �.Z;Z k �9��(u,.�s �v e,.e« Vl�a 9 x.z u 3 <br /> OWNER MALnODRE55 CiIY diP �HONE <br /> _�ahn /�/�;/,9tr a.2�,�1 qa�um> �vi �vPrefl �/l��i 9�SRU ? _ (.w6)_35 3=-Ztr6i <br /> TEY�NT MAILApDRF55 ��ilY lIF PHONF <br /> ARCHIiECTOPDE5IGNER M�II�DORE55 Cirv TiP �'HONF <br /> GENEBAIGONLR�CiOB MMIRDURE55 GfV ll^ P��UN[ ��RTEIICENSE♦ <br /> MECN�NIC�ICONTRACTOR MRIIADORE55 CItY ZiP PNONE GTATELICENSE• <br /> PWMBWGCONTRACTOR MAILRDORE55 f.1TV 11P PMONE $TAiELIGENSEY <br /> CONTRACI PRICE OF WORK <br /> HEA7ING SVSTEM: f � GAS f I ELECTRIC fl <br /> pESCRIBE VqRM AND$OUARE FOOTRGE INVOWED CONTACT PFPSON ANO PHONE NO <br /> .Fn fo�� t wOvc� 5 a — <br /> � HEFEBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> aaoroseo use or em�owc � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> I�I6me WORK WILL BE COMPLIFD W�T�� �NHETHER SPECIFIED HERE�N OR <br /> LEGKDESCRIPTIONOFPROPERtt�$MOWNBELOWOR/TfACMTWOCOPIES) NpT. THE GRANTING OF A P€Ftwl1T DOES NOT PRESUME TO GIVE <br /> �pT BLOCN._ _OF AUTHORITV TO VIOLATE OR CANCEL THE PROJISIOK OF ANV <br /> � O7HEFi STATE OR LOCAI LAW REGULATING CQNSTRUCTION OR TNE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORRED BV THE <br /> OWNEF OF ?HIS P6iGPERT� T4 PERfORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WffH TNE STATE <br /> CONTRACTORS LAW 1&27 RCW AND 296200 WAC. <br /> iARCEI TNt ID.Nl1MBER � <br /> GONSTRUCTION LO�N LENOER,ADDRESS,TEIEPHONE NUMBER X �� < I�//l/ /S <br /> SIGN BE A1° <br /> CITY BUSINESS IICFNSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl%TURE OR ITEM f�E NO. 7YPE OF EOUIPMENT F_ EE r_ <br /> WATERCLOSET�TOILET) A/C—AIHNDLGUNITS—H.P. __ <br /> BATHTUB FORCED AIA SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNITHEATERS—B.T.U. M <br /> KITCHEN SINK 8 DISP CLOTHES DRYERS ' <br /> DISHWASHER VENTILATION FAN ' <br /> RANGEHOOD <br /> � LAUNDRY TRR'{ --� <br /> CLOTHES WASHEH WATER HEATER _ <br /> URINAL WOOD STOVE _ <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BUFiN!NG) _ <br /> FIOOR DRAIN FIREPLACE INSEFiT(WOOD BURNING)_ ' _ <br /> � <br /> BACKFLOW PREVENTERS � GASFIREPLACE _ . ._ <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE . — <br /> GAS PIPING <br /> . EXHAUST FAN �_—. <br /> —_-T— <br /> SUBTOTAL $ _ SUBTOTAL S i <br /> PERMIT $ PERMIT $ <br /> TOTALFEE S TOTAIFEE 3 <br /> FOR OFFICE USE ONLY: -- <br /> FRONTSETBACK AEAH SETBACK SIOE SETBRCN PLRNCHECFNUMBFR � <br /> fFF RECPPTNO <br /> use[�x+E �ot eaen vecnNr srte � , VALUATIOM FEE T_ <br /> � I1YES t'� NO BUIIDMG <br /> HEIGHTLIMITpTiON NO.OFDWELLING SIZEOFBLDGrtI � <br /> UNIiS pLUM81NG �_ <br /> OCCUGANCY NO 0�SIORIES OCCUPAMT IORD BASE�dF.NT MECMANIf.AL _ <br /> GROUP -- <br /> fIVES II NO <br /> HDDITIONPL i'LPN CHFCK <br /> fIREALARMPEO'D RFn50N � <br /> OTNER <br /> FIRE SGR�NNLEfi REO'O AEASON STptE BUIIOMG SURCRRRGF <br /> iVPEOFf,ONST PlANSAPPROVEDBV CITYOFEVERETT �'��AI�f.WOPRS _ _ <br /> LOCAL SALES �-- <br /> oare TAX CODE IS 3105 70TqL _____._ _�____ <br />