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APPLICATII ,�1 FOR C�01�1�TRUCZ �<�N PERMIT <br /> CITY OF EVERETT• BUILGING DIVISION <br /> 3200 CEDAR STREET• EV[RETT, WA 98201 •259-8810 <br /> f] DEMOUTION f� COMBINATION CI BUILDIMG ❑ MECHANICAL fl PLUMBING fl SIGN <br /> PROJECT ADDRESS �(, L � �-. "� / <br /> f 1/E;ZG izFf�/ �il/ .J �/ l(iP-Tt"�i �'�'Zv3 <br /> OWNER MAILiWDRE55 QTY ZIP <br /> PHONE <br /> /�=:z�xi�.,,Hic� ?u� —/l',G�i�v'!il%1;��/�i r`�i�c �J00�% �/S U '� y�i <br /> TENANT MAII.qOJRE55 ��TM <br /> C;J Z�P PHONE <br /> /,C_ � �%�1% C�f,<��z ���1�� C�F��— >✓' ; <br /> ARCHITECTOFOESIGNER M�ILAODRESS ��ry � G <br /> Z�� PHONE <br /> GENERIAI;ONTpACTOq MA'ApDflESS CIT�'� 21P <br /> PIIOIlE STFTELICENSE/ <br /> .�- T,�,� . ,so�6iJo--��,� rl�/v�1/� �c/�;;�t 4yis.T 3�"i-z;�i 7�f'Tif/� GC' v�' av <br /> MECHANICRLCONTRACTOR MAILAUCRESS Clry ll� <br /> PMONE STATE LICENSE• <br /> PLUMBINGCONTRACTOR MAILADURESS ��ry Z�P <br /> �� (�c, PHONE STATE LICENSE� <br /> "f�(���:� — <br /> C TRACT PfiICE OG WORK <br /> ��•L'��'�'; / � � c�.l�/ ;�/,'/�' ��C � HEATING SYSTEM: L'�GAS fl ELECTRIC fl <br /> DESCRIBEWORKANDSOUAREF TA EINVOLVED <br /> r�� ` � � CONT PERSONppi PHONENO <br /> /'�?�:�/' . l�00 C��%-��iC[E !Uo/'� `,�ilL �.nr�J�o-✓ J�%-��c�C <br /> �, <br /> /���i�/� Cr/C�/✓G '/�E� <br /> I HEREBY CERTIFY THAT I HAVE READ AND FXAMINED THIS <br /> PROPOSED IlSE OF BUILDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> u'.Z -'���� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS 7YPE OF <br /> LEGALDESCflIPT10NOFPROPERTY�SHOWNBELOWOFiATfACHTWOCOPIES) WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HER[I1J ^i <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW qEGULATING CONSTRUCTION OR THE � <br /> PERFORMANCE 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 /> PARC�L TA%I.D.NUMBER CONTRACTORS LAW 18.27 pCW Ayp 2g6.200 WAC. <br /> G Z -GD�- ? - o0 00 � ! <br /> CqYSTRUCTION LOAN LENUER,ADDRE55,TELEPHONE NUAIBEq x �. ,v . � �//(n� ��// <br /> ) <br /> SIGNATURE 'bAT <br /> CITY 6USINE55 LICENSE NO. <br /> PLUMBIN6 MECHANIC.AL <br /> PdO. TYPE OF FlI(TURE OR ITEM FEE NO. TYPE OF ECUIPMENT FEE <br /> � WATERCLGSET(TOILET) � A/C—AMp�DLO,UNITS—H.P. � <br /> BATHTUB ' FORCED Alfl SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BA91N; � HEAT PUMF � <br /> SHOWER ' UNIT HEATERS—P.T.U. M i <br /> KITCHEN SINK 8 DISP _ ; CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRYTRAV ; RANGEHOOD � <br /> CLOTHES WASHER � WATER HEATER , <br /> URINAL ' WOOD STOVE � <br /> DRINKINO FOUNTAIN � METAL FIREPLACE(WOOD BURNING) ' <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR, ETC.) � GAS RANGE , <br /> ' GAS PIPING � <br /> � EXHAUSTFAN � <br /> i � <br /> ' <br /> � <br /> � <br /> � <br /> SUB TOTAL $ ; SUB TOTAL $ � <br /> � <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE $ � TOTAL FEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACN REARSETBACN SIDESETORCN PLANCIIE NUMOER F[E qECEIPTNO. <br /> USEZONE LOTAREA VACRNTSITE FEES ��TON FEE <br /> fIVES fl NO pUILDIk. ` i <br /> NEIGHT LIMITATION NO OF DWELLING EIIE OF OLDG?.I. <br /> � � i � <br /> U!llfS � <br /> r v PLI1MtlING � <br /> OCCUPANCV NO OFSIOflIES OCCUPANTLOFD BRSEMENT I <br /> GA��P � � MECNRNICAL � <br /> � 1'IYES Yf1�0 � <br /> FIflEALARMREO'D REASON ADDI710NALPLANCHF.GN i <br /> E �K�St in1�� S Y Sfi�Yti � <br /> OTMEA � <br /> FIRE SP`R�INKL(ER REOD REASON i <br /> v�J F��5{��� ���J`�1"` STq7E DUILDINIi SIIRLHAfiGE �� ' <br /> rrre o r,oNsr PLANS�cpovEo ev CITY OF EVERETT PUOI IC WO(1K5 � <br /> � / � / /!n LOCAL SALES ' <br /> V DATE I I —/ � �S f TAX CODE IS 3105 TOTAL � ! <br />