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APPLICATiC 1 FOR C��➢.�,YFiUCT'� i�l PERHAIT���� <br />CITY OF EVERETT • PUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8010 <br />❑ DEMOLITION p f,•OMBINATION izJ BUIIDING �MECHANICAL � PLUMBING ❑ SIGN <br />PROJECT ADDRESS:_ r1 �� `� /-1� ,L.`�"�.`-�'_ ����i-�'�� _ <br />\,veS T �yoAST 2JVC _��ry"TC _ �)YZ�I 2.5 z ?_:i-c�! <br />OW11ER M�R�OUf1E55 f.IIV 7�� PMONE <br />1ENANT MqI�ODf1[SS fllY IiP PI�ONE <br />AqGN1iCCTOl1DE51GHEP M��IADORE55 C�n' iin PIIO�+F <br />GENEfiNCON111ALT0l1 YSIlA00f1E55 CIIv liP PnONE Sf�lEItCENSE� <br />NU({ VQOWAI CPV:1T 7SCF (c/ Ao��� L/L .S%/�a��S 5'4z> F zs z z� �� DUV l�J��- �»�A <br />MEC11�11iCQCONTRILTOB MAILADOilE55 G1V I�P PIIORE SGiEUCENSE/ <br />P1U481NGCONIR�C70R MULADORE55 CIfY :IP PIIONE SUfCUGENSE� <br />lj." ,' �/ ��7 <br />�ESCPIBE N9RN �NU SOU��E FOO7�GE INVOlVEO <br />�0 1� �Jr% <br />�a�� <br />lOT � OLfF.N <br />P TAIf D..:lu7kR <br />Or o�" - 3�J 3 i roS �o <br />CONSTRlIC00N lON1 LEN�ER, AOIXIE55, TELEVNONE NUMBEII <br />PLUMBIN6 <br />NO. TYPE OF FIICTUNE <br />Z WATER CLOSET (fOILE <br />BATHTUB <br />7 LAVATORY fWASH BASINI� <br />KITf.•HEN SINK 6 DISP <br />DISHWASHER <br />UF:NAL <br />��iIhKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTEHS <br />AINK IAFRVICF _ RAG FT <br />ITEM <br />SUBTOTAL f <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />i00NTSETBACN RE�RSEiB�CN <br />20' Zo, <br />USE ZONE . LOi �RU <br />_ �-� �c0%� <br />IIEIGIIi LIMITIITIOH HO Of DWELIINC <br />Zp UNIIS I <br />lJ <br />OCCUPANGY Iq MSIOwfS OCLUP�NfL0�0 <br />cna <br />�3 v- I <br />FIIiESPRINNLEPREO'0 �E�SON <br />fIREAIMMPEO'D RF�SON <br />fYl'FOff,ONSI P�ANSAPI�f10VEl <br />��L a�re12 � <br />S.S �5�95 <br />SIDE SFIO�Ck <br />HEATING SYSTc'M: ❑ GAS ❑ ELECTRIC ❑ <br />GONTACL 1'f1150N �NA PMONE NO <br />I HEREDY CERTIFY THAT I HAVE READ AND EXAMiNE� THIS <br />APPLICATION AND KNOW THE SAME TO �E TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECI�IED HEREIN OR <br />NOT. THE GRANTING OF A f'ERNIT DOES NOT PRESU�AE TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PqOVISION OF ANY <br />OTHF.R STATE OR LOCAL LAW REI±ULATING CONSTHUCTION OR THE <br />PERFORMANCE CF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PRGPERTY TO PERfORM THE WORK FOR WHIGH <br />APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br />CONTRACTORS lAW 18.27 RCW AND 25G.200 WAC. <br />�JQ,.�— /� -iv • y!v <br />51fN�fUf1 DAiE <br />Cltt BUSINESSIICENSC NO <br />MECHANICAL <br />FEE NO. TYPE OF EqU <br />� A/C-A/HN�LGUNRS <br />; FORCED AIR SYSTEMS <br />� HEAT PUMP <br />� UNIT HEATERS <br />; � CLOTHES DRYEHS <br />� RANGEHOOD <br />; WATER HFATER <br />� WOO�STOVE <br />� METAL FIREPLACE (WO( <br />; FIREPLACEINSERT(WO� <br />—�— GAS FIREPLAGE <br />; GAS RANGE <br />� GAS PIPING <br />. � EXHAUSTFAN // <br />V���NI SIIE <br />�YES C NU <br />512E OI OLW/11 <br />❑YES NO <br />ri.r� c��ecK �+uuarn <br />� �,��,:�+ / <br />fIUIlO�HO <br />Pl11AlOWG <br />MEf,IUNiL�I <br />•001 f IONq �UN LIC LN <br />nillClt <br />$i�tE OUROiHf.S�InC11M10C <br />CITY OF EVERETT runur, wonK� <br />LOCALSALES <br />TAX CODE IS 9105 TO7AL <br />SUO?OTAL f <br />PERMIT S <br />TOTALFEE S <br />rec I ntcemr r�o <br />391�. c_a <br />C/ �O <br />_ �n� <br />i � , <br />J:r � <br />—��—� <br />