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APPLICd�T14�n1 FOFt CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> ❑ DEMC!!TiON f-1 COMBINATION I�BUILDING f� MECHANICAL rl PLUMBING fl SIGN <br /> PpOJECT ADDRESS ��J ������K� 1�� S� <br /> O�(!�N��Y 'I' G�/ILADDRESSIIIVO �1� ��'�(iK� (J�1W�Y�R-- ���p� 1�'� � ] �] <br /> I / I / <br /> iENAN!' MAILAOOAC55 GITY ZIP PMONE <br /> �� <br /> ARCHITECT OR OESIGNER MAII.ADCRESS CITY 71P PMONE <br /> n��lM - V�tt2��1 /9�z �(I�T A-V� '�II ao 5�A-71Zr'= �ufr. �I� I �Ig -z69 n <br /> GENEfiQLCO��ACTOR MAILADDBE55 CITY ZIP PNONE STATELICENSE� <br /> ^%7 cc � �, r �o������� c�m�i-������, <br /> MECHANICAL CONTRACTOR M I FUORESS CITY ZIP PIIONE STATE UCENSE� <br /> PLUMB�LON7RACTOP MAILADORF.SS Cltt 21P PHONE STAiELICENSE� <br /> CONTRACT PRICE OF WORK <br /> DD ppp HEATING SYSTEM: fkl GAS fl ELECTRIC I-1 _ <br /> D SCRIBE WORK AN�SOIIARE FO TAGE INVOLVF.D GONTACT PEFSON AND PHONE <br /> �I��.� ��tNn�� � �hsclft c��✓s����on/ yib rif� lI� <br /> /K �X r�inl� -�(.ta.`, � ���i l���. ►��'�nt7�-j - U�l�� `C� -z� r� <br /> �Y"r}}�(� �/l�'PP�/IL�i G/=n17}=l� � �� I�� J� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROPOSED USEOF PUILOING PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMP!IED WITH WHETHER SPECIFIC-D HEREIN OR <br /> LEGALDESCRIPTIONOFPROPEfiN�SHOWNBELOWORRTfACNTWOCOPiES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCK__OF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> F�— O7HER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> �=r ��UI(�� CD(�F�SN+h— PERfORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> �J32 -o�l -b�Z - a�o7 �� ��� COPT TIORSI AW 1827FiCWAND296.00LWA�WITH TIiE STATE <br /> PARCEL TAX I.O.NUMBER �� <br /> CONS UCTION LORN LENDER.ADURE55,TFLEPHONE HUMBER x / '��� I I I / I <br /> SIG AiURE DATE <br /> CIN BUSINE55 LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—NHNDLGUNRS—H.P. ' <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP ' <br /> SHOWEA � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS � <br /> � <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRY 1'RAY ; RANGF'HOOD � <br /> CLOTHES W:45HER � WATEFi HEATEF ' <br /> URINAL ' WOOI STOVE � <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS i GASFIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE ' <br /> � GAS PIPING � <br /> ; EXHAUST FAN � <br /> i <br /> � <br /> i � <br /> ;�;; SUB TOTAL $ ' SUB TOTAL 3 ; <br /> Vj�^ PERMIT S � PERMIT 5 _�_ <br /> �`�-�� TOTAL FEE 5 � TOTAL FEE S ' <br /> :;4 <br /> FOR OFFICE USE ONLY: <br /> FRONT SEiAACN REAR SETBACK SIOE SETBALN �l�N CIIECk 1��O[R FEE �� RECEIPi NO. <br /> ( S—n oJ ,��% <br /> USEZONE-� rJ LOTAPEA VFCANTEITE FEES VALUATION FEE�_ <br /> k-.� (� f1YE5 'O ppILOWf. GUO � <br /> './ <br /> IIEIGHTIIMITATION NOOFDWEWNG SIZEOF9LDGRI. ��D' �/�n <br /> UNITS L��y,�d.�ryy���� D,��L PL11M01NC ��� <br /> r w�y� �" <br /> � <br /> OCCUPANCV NO 0�Sf0�165 OGCUPANiL0A0 BASEMENT MECH.�NICnL � <br /> GROUP � '- <br /> u� flYES q,'NO � <br /> FIRE ALAqM REO-� REASON aDDI110NAL M AN G�f.CK _-_;_ <br /> u� ' <br /> OiHER � <br /> FIRE SPRINNLER REO'D FE�SON <br /> �p� ST�TE BUIIOMG SURCHARGE ;� <br /> luV <br /> iYPEOFfONST rinHsnv�n vEoer CITYOFEVERETT runur.wonres —�— <br /> �J LOCAL SALES ' <br /> � �ATE �1 �1 7�j TAX CODE IS 310� To7A� - — <br /> �Z.S�D <br />