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APPLICATIQ"' FOR CONSTRUC'ir')N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION �J BUILDING /K-MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS <br />��.�C7 �'`�iG�rc�n �c�S Lvc_c� �/� �lSS1o'} <br />owrven Mnaaoont::s r arr � zir rHone <br />J G E��.-�1'}' �LG ! I1 �o zE b+K sr �.u..,,,� 9�cc{ H Ls- is �S <br />TENANT MAILADORE55 CITY ZIP PHONE <br />(�io-ll�. w�vnv� �0�10 Lv.��.r.�....4,.� ��•r�G1-F 9�1�3 �i3 ` %'$�–S . <br />ARCMITEC fl ESIGNER MAILAOOfiE55 '� CITY ZIP PHONE <br />GENEMICONTRACTOR MNIAD�f1E55 CITY 21P PHGNE JTATECICENSE� <br />+�n.nea Lowo....y�_�gld II(.f"'Aw'�1� (�cl(.�..e' QifOv•f �tY35637 .�<w.e5ex oqH�SP <br />MECMMlICALCONTRAC� MAIIADDflE55 Cltt ZIP Pl10NE STATELICENSE� <br />/��f,� � F I q� a8 ! Y9"'l��� Ne L�..�.1: �:i� 4a �lYo "lJ�. ��fff3S65! Ao v�N FP i�1=�c?6 <br />PLUMBINGCONTRAC70R MWLPDDRESS CITV ZIP PHONE STA7ELICENSE� <br />� <br />r i <br />INVOLVED <br />5 <br />C /�� (,f � r-r <br />r� <br />PROPoSED OF BUILUING <br />LEGAI DESCRIPTION OF PROPERTY <br />l0T PLOCK _ <br />s �� �-rr <br />OF, <br />CONSTAl1CT�ON LOAN LENDEfI, ADOfiE55. TELEPMONE NUMOEq <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILEn <br />BATIiTUB <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SUB TOTAI $ <br />TOTAL <br />FOR OFFICE USE ONLY: <br />FBONT SElOACK flGAfl SETUACK SI�E SETOACN <br />USE ZONE <br />HEIGHT LJMITATION <br />OCCUPANCY NOAF <br />GPOUP <br />LOTARER <br />NO.OFOWELLING <br />UNIfS <br />FEE <br />VnCANT SITE <br />❑YES ❑ NO <br />512E OF OLIX'+?.I. <br />6ASEMENT <br />❑YES ❑ NO <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACT PERSON ANO PHONE NO. <br />�_ r InL_�S!>� _/L. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND ORDINF,iJCES GOVERNING TiiIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OF <br />NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TC �'�E <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF n:. f <br />OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEp DY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICAT�ON IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />X ni�G�,v ,�i –`i _ �t � <br />SIGNAT E U�TE <br />CITY BUSINE55 LICENSE NO. <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM � <br />AIC –MiNDLG UNITS – H.P. <br />FORCEDAIRSYSTEMS–B.T.U. M E.A. <br />UNIT HEATERS – B.T.U. M <br />CLOTHES ORYERS � <br />VENTILATION FAN ' <br />RANGEHOOD � <br />WATER HEATER � <br />WOODSTOVE ' <br />METAL FIREPLACE (WOOD BUHNING) i <br />FIREPLACE INSERT (WOOD BURNING) � <br />GAS FIREPLACE- i � <br />GASRANGE � <br />GAS PIPING ' � <br />EXHAUST FAN � <br />—,— <br />�i 5 �^;1�� c✓�s S � — <br />� <br />� <br />� <br />SUB TOTAL $ � : <br />PERMIT $ � <br />TOTALFEE E ' � <br />PIAN CIIECK NUMq:Aj � FEE RECEIPT NO. <br />PUIL�ING <br />PlUM01NG <br />IAECIIANICAL <br />AODITIONAL PIAN CHECK <br />OTHER <br />STATE OUIlDINO SllliCHAlIGE <br />CITY OF EVERETT PUOLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL ; <br />Y <br />