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�y� rx., <br />APPLICATf.Lrd FOR CONSTRrJCt rON PEFtMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERE:TT, WA 98201 • 259•8810 <br />f7 DEMOLIT'i'vid rl COMBINATION f-1 BUILDING � MECHANICpL ri PLUFJIBI�JG f-! SIGN <br />PROJECT ADDHESS , _ _ _ _ , � <br />cin <br />MPILAODRESS <br />na r�wr+e <br />PRCl/ITECTOROESIGNER � MAILADDRE55 � Gltt' " Ln' �'roht <br />iki.. A Glassni�v 1�C�5 �36"' PI• 1VE. "�b�{ �eile�[�-e �16005 � i�L�O-bisU <br />C�ENE(tALLONTRAGTOR MAILAD�PE55 Gltt ZIP PIIONF STATELIC[NSEt�'3-8'�O^jf�.j� <br />� ' .' ' " _ _ " . _ __ ... �.� '_�.. n L <br />CONTRACTPRICEOF WORK �.�` Q� f OOO �— <br />�l <br />DESCRIBE WORN AN� SOl1FRE FOUTAGE I4VOLVEU <br />TI wer1� Fk� nu.� c.sa\�s ��,�T� <br />New (3n�4l�cc�+tt�-cFF<ce t Qcenkreolti� <br />�id�'�•WC�` CF I'F� Cci'� E�MN't �"I{LN H) <br />PRO SEDUS OFBIIILUING <br />��'�Q' � <br />LEG�l0�E5yC�RIP�TION OF PROPERTY (SHOWN BELO'N OR ARACN TWO COPII <br />LOT _(�_ BLOCN OF <br />Wo yr,Nz,tis etx>F�, 1-S: �� O:u <br />�(¢E (JoL /0. oF pla�s p 83 Sf <br />PARCELTAX I.�. NUM9ER <br />3�t 3 t� - ooc� �- ob - o 0o a s,rao -oo� <br />CONSfPUCTION LOAN LENUER. PDDRE55, TELEPHONE UMBFR <br />TYPE OF FlXTURE OR ITEM <br />WATER CLOSET {TOILEn <br />BATHTUB <br />SHOWER <br />KITCHEN SINK 8 DISP <br />CLOTHES WASHER <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />RINI[fCFRVICF—RAR El <br />SUB TOTAL S <br />PERMIT S <br />FOR OFFICE USE ONIY: <br />FRONTSETPALN REAA SFTBACK <br />USE ZONE <br />HEIGHT LIMITFTIDN <br />OCCUPANCY NO Of <br />f.PO P � <br />FIRE RIARM RE00 <br />Y� <br />PIfiF. S��INKIER REC <br />4C�� <br />TVPE Of f,ONST <br />7l- I kr. <br />LOTAREA <br />NO.OFUWEWNG <br />UNIiS <br />OCGUPANTLOAD <br />SIDE SETBACN <br />HEATING SYSTEM: 1�'GAS �ELECTRIC fl <br />LONTACT F5P $ON AN� P�ONE NO <br />GM,._Y. T .OQ\ �iU_QAl'1LI <br />I HEREBY CERTIFY THAT 1 HAVE RERO AND EXAMINED THIS <br />'APPLICATION AND KNOW THE SAME TO BE TH;IE AND CORRECT ALL <br />PROVIGIONS OF LAWS AND ORDINANCES GOVEP.NING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PfiESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER S7ATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCT�ON. 1 HAT I AM AUTHORRED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FON WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAN.' 1827 RCW AND 296200 WAC. <br />�cn -S- S <br />SIGNATU E 1 DATE <br />� <br />CITY BUSINESS LICENSE ND. <br />MECHANICAL <br />NO. TYPE OF E�UIPMENT FEE <br />rv�-rvnrvuw urviia-n.r. <br />FORCED AIR SYSTEMS - B.T.U. M E.A. <br />HEAT PUMP <br />UNITHEATERS-B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WOODSTOVE <br />METAL FIREPLACE I <br />FIREPLACE�NSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL $ <br />PERMIT S <br />TOTALFEE $ <br />PLAN CII[CK NUMOFP ��„ I FEE _ �,_ _ I�ECEIPT tlO. <br />VACAN7 SITE �CCJ <br />f1YE5 fl NO BUILOING <br />SIZE OF OLDGRI <br />d2vl�WNlG� <br />RF��ON <br />a�!'Nr� /j.. <br />PLANS APPROVEO OY <br />DATE I/S/'�1� <br />GGr � /_' t PLUN�ING <br />� �r <br />CSEMENT MEGHANICAL <br />f1VES iCNO <br />�DDI710NAL PI�N CIIECK <br />Oi11ER <br />`�IF//'�'Y'�/.I'7//�� SIDIEBUILDWG5URQIARGE <br />-.w�ir i� � ir..,� <br />CITY OF EVERETT ruoucwonKs <br />LOCALSALES <br />TAX CODE IS 3105 70TAL <br />