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APPLICATIvN FOR CC'iidSTRUCI t4N P@RMIT <br /> CITY OF EVERETT• BUILDWG DIVISION �� <br /> 3200 CEDAR STfiEET• EVERETT, WA 98201 •259-8810 <br /> f I DEAIOUTION f I COM8INATION i I BUILDING I I MECHANICAL � I PLUMBING f ! SIGN <br /> PROJECT ADDRES <br /> - � — y �' `� � cr� <br /> OWNFR MRiLp00qES5 (:;"Y Tu' PHONE <br /> tENANf MMIAppRF55 CIIY IIP n��pNE <br /> ARCNI1Ff.TJR0E51GNER MRIIFCIDBE55 CIiY )IP PHONF <br /> -ENEnnLGONflleCt(Ki � I MnIL�ODRESS Clrv IIP P�IDNf. S�ATFIICENSE� <br /> �%�e-� Lu�,K �1�,ar-� Til I ��� S�I/I�� YI�IR:SViGLE.I/�W��L'�C 6s-3-3�zc� �3v2S�c.i+i 1�[v� <br /> MECMnNIC0.l CONTRACT Ml ADDRE55 �Tv- ZIP PIIONE STATE LICFNSE� <br /> :S ,k . - (' , - k=-�. {ll1 i #qzi f�n: uN� 1�Y %4f��=raR �c�+��:xx�c�s�r�.. <br /> II�MBIN CONtRAf,ipR M0ILADDRE55 �y�,{� (/1�� ���Y( �� PHONE STAt LICENSEM <br /> � �� � Y- ll�T �A�Y� Z � r� � Z' 'S' . O � <br /> CONTM !vpN;E OF wOR S <br /> _LQ ��(� HEATING SYSTEM: I GAS ��l ELECTRIC f l_ _ <br /> p[�CRIBE W�iRN AND SUUARE OOT/�GE IN 0.9C-0 C iACT PFR$qN AND FHONE N/�� /\ / �S J ����0 <br /> � L X. i uri,i <br /> � � if.�• v <br /> —� �t� C L <br /> I HEREBV CEFTirV ?HAT 1 HAVE READ ANU EXAMWED THIS <br /> Pa�c�sec use oF euaon+c APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> ` ; ;� PROVISIONS OF LAWS AND ORDINANCES.GOVERNING THIS TYPE JF <br /> ���� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �eeniDEsc PPONOFGROPERTY�SMOWNBELOWORFTfl�CM;TWOCOPIES� NCT. ThE CaRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> iot�e�ocK oF AUTHORITY 70 VIOLATE OR CANCEI THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATWG CONSTRUCTION OR THE <br /> �4'�� �.rY� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZEO BY THE <br /> OWNER OF THIS PROPERTV '�O PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE P.ND I COMPLV WITH THE STATE <br /> wacEi Ttiv�o Bea � � C NTRACTORS L 1827 RCW D 296200 WAC. <br /> SCSZ��0.�o -vil <br /> CONSTRUCTION IO�N LENDER ADDr�ELS_Sr.TELEC/H-ONi NUMBER �'°L _. (� , � (,��j� <br /> G�� �}F[N�J lL'S � '- SIGNA I;RE �DATZO .. C�'� <br /> SL CITY BUSINESS IICENSE NO. <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FU(TURE OR ITEM FEE NO. 7YPE OF ECUIPMENT FEE <br /> �� WATER CLOSET(TOILET) A/C-AMNDLG UNITS-H.P. <br /> a BATHTUB FORCEDAIRSYSTEMS-B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) HEAT PUMP <br /> SHOWER UNITHEATERS-B.T.U. M <br /> KITCHEN SINK 8 DISP CLOTHES DRVERS <br /> DISHWASHER VENTILATIQN FAN <br /> LAUNDRYTRAV RANGEHOOD <br /> CLOTHES WASHER WATER HEATER <br /> URINAL WOOD STOVE <br /> 7RINKING FOUNTAIN METAL.FIREPLACE(WOOD BURNING) <br /> � FLOOR DRAIN FIREPLACE INSERT(WOOD BURNING) <br /> BACKFLOW PREVENTERS GASFIREPLACE <br /> SINK(SERVICE-BAH,ETC.) GAS RANGE <br /> � � GAS PIPING <br /> EXHAUSTFAN <br /> � SUB TOTAL $ � SUB TOTAL $ <br /> PERMIT $ PERMIT $ <br /> TOTAL FEE $ TO fAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONI SPiAACR REAP SFTBACK SIDE SETBACN � PLAN CHECN NUMAFR FEF pECE1PT NO. <br /> 2`� Zo� � �/7j � ,3� � �C!�� — <br /> usezoue � I �otA�d� vncn�vrsl.re FEES VALUATION FEE <br /> � T_ <br /> r Es r�� No eu�inwc Z a�,S3 /.�3 , 7� <br /> HEIGMT LIMITATION¢ NO OF DWEILING SIZE OF BLDG�I1 <br /> 2u uuirs / 16�� S,F. L�Vi.r4 } riunnewc . ___� ' Icri� <br /> S 4F. G?RA4C __._—_ __..—— _ <br /> (,`CCUP�NCv NOnvctnaip5 OCCUVANTL04p BASEMENi MECMnNICAL <br /> GROUP _.__��__ <br /> d_J V_� y � � IIVES O — . <br /> �,� - AD�I11pNAL PIAN CHFCK <br /> FIRE URMREO�L1 �FASON _ <br /> OtHFR -- <br /> FIPf SPRINKIERRFOD PFAGON -- �� �� � <br /> SiAiE BIIIIDMG SUf1CHM6E ' <br /> rvvecMcnnr,r rinNs�vvnovFnAv CITYOFEVERETT ��iniicwon�� 2(/ ; / <br /> �J I� LOCAL SALES -- -- -- .... _____- �- �� / <l <br /> _�__ _ . „�rE. �4/�� TAR CODE IS 3105 7oTA�— -- .— - --.��!�_,.2__� . <br />