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- _ N PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STAEET• EVERETT, WA 98201 •259-881D <br /> 17 DEMOLITION [-1 COMBINATION r1 BUILDINu' �ci MECHANICAL i� PIUMBING i-'i SIGN <br /> PROJECT ADDRESS <br /> L' `" .,. — " i:,3 <br /> OLNIER MniLApDqE55 CItY 2iP PI10NE <br /> -�r �.n.2t� Icti�_ILS 47d $- �O( r�-1 �vs ' de�' 6f `/F "' � 3 'L S 2 /�'+ 'L2 <br /> 1EN�NT AIqILApDqESS CITY plP PHONE <br /> ARCHITECT ON DESIGNEq MAIL AD�RESS dN ZIP PHONE <br /> GENERALCONIIinLTOq MAILAWRE55 CITV Zm PHONE STATElJGENSE� � <br /> NECHANILAL WNTRACTOP MpIUD�PE55 CIIY Zlp PNONE STATE IICENSE i ' <br /> �/( �)�L� <br /> PWMBIYGCONTRACTOR MRILAD�PE55 CIiV ZIP PHONE $TATELIGENSEM <br /> CONTR�CT PRICE OF WpRK <br /> - —C�j HEATING SYSTEM: ,i�GAS ❑ELECTRIC ❑ <br /> OESCRIBE VJORKAND SOUARE FOpTFGE INVOI.VEO / COTNTACT PERSONANO PHONE NO. <br /> C C� �'7 _l/L- .� �� <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> FROPOSEDUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ,G � _ PROVISIONS OF lAWS AN�ORDINANCES GOVERNING THIS TVPE OF <br /> WORK WILL BE COMPIIED WITH WHETHER SPECIFIED HEREIN OR <br /> IEG�LDESCRIPT�ONOFPROPEHTY(SHOWNBEIOWORqTTALHiWOCOPIES� NOi THE GRANTING OF A PERMIT DOES NO7 PNESUME TO GIVE <br /> tor e�ocK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> AERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTAX IA.NUMBER CONTRACTORS LAW 18.27 RCW ANO 296.200 WAC. <br /> � <br /> CONSiRUCiIONLOANIENDEP.ADDRESS,TELEPNONENUMBER X � °/'L�tY �� /��� 3 - / - �r <br /> SIGNRTME DATE <br /> CITV pU51NE55 LICENSE N0. <br /> PLUMB�NG MECHANICAL <br /> NO. TYPE OP Fll(TURE OR I7EM FEE NO. TYPE OF FIICTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. � <br /> BATHTUB ; FOP.CEDAIRSYSTEMS—B.T.U. M E.A. ' <br /> � <br /> LAVATORY(WASH BASIN) i NEAT PUA1P , <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRYlRAY � RANGEHOOD <br /> i <br /> i <br /> CLOTH=S WASHER WATER HEATER , <br /> URINAI ' WOOD STOVE � <br /> DRINKING FOUNTAIN ; A7ETAL FIREPLACE(WOOD BURNING) ; <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) <br /> BACKFLOW PREVENTERS ; GASPIREPLACE � <br /> SINK(SERVICE—BAH,ETQ) � GAS RANGE <br /> ' GAS PIPINIi � <br /> i EXHAUSTFAN � <br /> ' ' <br /> SUB TOTAL 3 ; SUB TOTAL 5 � );°� <br /> PERMI7 5 i PERMIT $ / �6 <br /> TOTAL FEE $ � TOTAL FEE $ �oO <br /> FOR OFFICE USE ONLY: 7� <br /> PRONT SETAACN qEM SETBACK SIDE SEiBRCN PIAN CH[CN NUM9GR F[E RECFIPT NO. <br /> USE ZONE LOTAREA VpCANT SITF FEES VALUATION FEE <br /> flVES fl NO pUIL�ING � <br /> MEIGMTLIMIT�TION NO.OFOWEWNG SIIEOFOIOGRI <br /> � <br /> UNITS i <br /> P W M[IMG � <br /> OCCUPANCV NO OFSTOFIES OCCUPANTLO�D BASEMENi I <br /> GFOUP MECHnNICAL I <br /> ❑YES fl NO � <br /> i <br /> PIREAURMREOV REPSON pODI710NRLPLANCM[CH � <br /> � <br /> O1NEF I <br /> FIPE SPRINKLEP REO'D REASON <br /> S7ATE BUIL�ING SURCH4RG[ � <br /> TYPEOFCONST. PLANSA�PPOVEDBY CITVOFEVERETT �'UOLICWOfiKS i <br /> LOCAL SALES ' <br /> ppTE TAX CODE IS 3105 TCTAL ; <br />