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_ .-. <br /> APPLICATII..�� FOR Ca1�ISTRUC7 ..:h PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STR�ET• E'JE9ETT, WA 98201 •259•8810 <br /> ❑ DEMOLITION �[ COMBINATION �BUILDING L�"MECHANICAL „�PLl30YIBING p SIGN <br /> PROJECT AUDRESS: a - � � <br /> ��'f11 t� .�'v>�, I��f'Z��n 9 T n qz�' 3�,. 7o L/-/'rz s Z <br /> R MuI�DDRES <br /> X�c�er P�t� ,�� Zs' N� /in_ st' se� 93/ as �3��-- i�a a <br /> 7E1UlIT M�ILI�DDiiE55 CITY 21P P110NE <br /> 3� Pr-2 s �uj- 7-' — <br /> IIR�INTEGTORDE5IGNER MNIMDRE55 LI�'Y 21P nvr�NF. <br /> �3j NEMIGONTMGTOq MNL/�DDFE55 LIIY ZIP ����CP�NE SIATEIICENSE/ <br /> ^ �.¢�C.c/A-!f !�/ / �Z/ 3 r��4 d P n!� SF�t 9�'/�s' /�a,ci.4.�'�U5�'R p <br /> ME �CAICONTNACTOR M�ILADDRE55 CITY ZIP PIIONE STATELICENSE� <br /> PLUAlklGCONTRACTOR b!AILAOq1E55 CIN ZIA PHONE STATELICENSE� <br /> � u /i �L S2- LGU <br /> ONTMCTPRI� N <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> pE,iCpBE YpBN ANO SW�RE FOOTAGE INVOLVED CONTACT PERSON AND�HONE NO. <br /> u� o � N <br /> / �/ <br /> O �!� �'L� K � I HEREBY CERTIFY THAT I HAVE READ A�D EXAMINED THI� <br /> APPLICATION AP1D KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> rnaros[o use oF eu�ar+o PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHEfl SPECIFIED HEREIN OR <br /> LEC.liLOESCRIPTIONOFGqOPERTY�5110WNBELOWOHATTACHIWOCOFIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVF. <br /> ioT e�xK oF AUTHURITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOHMANCE 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 /> PABCELUJ(I.D.NUMBER — CONTR LA 1827RC N�6200WAC. <br /> CONSTINICTION IO/W LENOER,AOORESS.TELEPHONE NUMBER v � O C <br /> �T E DATf <br /> CITY BI151NESS LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlI(TURE Op ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILEn � A/C-A/HNOLG UNRS ' <br /> BATHTUB ; FORCEDAIRSYSTEMS ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNIT HEATERS . ; � <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS � <br /> DISHWASHER � HANGE HOOD � <br /> UUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER� � WOOD STOVE � <br /> URINAL ' h7EfAL FIREPLACE(WOOD BURNING) ' � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> SINK(SERVICE-BAR,ETC.) � GAS PIPING ' <br /> � IXHAUST FAN <br /> - � <br /> � <br /> � ' <br /> � ' <br /> � ' <br /> � ' <br /> SUB TOTAL S ; SUB TOTAL 5 �— <br /> PERMIT E � PERMIT S � <br /> TOTALFEE S � TOTALFEE : ' � <br /> FOR OFFICE USE ONLY: <br /> FRON75eTBACK RE�RSETB�CN SIDESET9AGK �LANGIIEGNNUAIBEf1 �EE REf.EIPlNO <br /> USEZONE IOTAREA VAC�NTSI7E FEES VALUATION FEE <br /> i <br /> ❑YES O NO BIlIL01Nf. '^ �� <br /> HEIGMT UMITATION NO OF�WEILING SIZE OF glDC?.I ��,((( <br /> UNI�S � ��� <br /> O PLUMOING <br /> i <br /> OCLUPANCY NO OF SI(%YES OLCUP�NT LO�D BASEMENT � <br /> �R MECM�NIC�L <br /> / /v� ❑YES NO � <br /> AODI IIONAL PUN CHECN i <br /> FI'lESPPINKLEHREO'D AEASQ"! -- <br /> _ 1 <br /> �i/J OTIIEP i <br /> FIREAUAMREO'D HEACON � �J� <br /> N' I $iAIE BUILDING SIIRC1ufIGE �L/ <br /> TYPE OF f,ONST PL�N�ROVED BY CITY OF EVERETT �IIAI If,WOPKS � <br /> � IOCAL SALES —�— <br /> � - N f ' � a � TAX CODE IS 3105 TOTAL <br /> DATE �� <br />