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\ �. � <br />APPLICATIO.� FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />� %� �� � <br />�, OEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING � SIGN <br />PRuJECT ADDRESS: ��-t$-} C- V C- Q�S I-' EEN W A`1 <br />OWNER�G� b��v��LAOD EA 55 ���� E� ��� IIP P110NE <br />�`,,,�i X-Cr����tr6 IoBZS n�C- Z"'D ��LLCVUC-. wA `t8cv'1 y55'��yb <br />TENANT �A�IIMD(IE55 CIIY 71P PIIONE <br />P„w�� X-�ctnuC;E lofl�ZS nic- 2""' S3C-c.t-��ru6 W� 9800b us5-o�u�, <br />AfICNrtCCTOf10E51GNEn M�IIADOfiE55 Gltt 71P PIIONE <br />GENEMICONIfuG1IXi M�ILAD011E55 GI1Y 7�P ��IONE $fUEIICE�4E• <br />f�o LrrL S� c�i S�s� c-r�.5 I Z932 t.l� I UT'' PL 6�LL��IUi. \NN a SOOS _ <br />MECHANICALCONTHpCTOR MAILADDRE55 f.ITY ]IP P��ONG STAiEULENSE• <br />C-Ohrr I SG O�-f �-1 J-� <br />PLUTABINGCONTRAf.TOR MAILADDilE55 LIIY ZIP PNONE STAIELICENSE� <br />l�Vl'�1�1wy1 rl���.t V� AV1�1� <br />$ y ;-� �, I , S O <br />UESCRIBEWORKA4DSOU�HEFOOTAGEINVOWEO �� <br />�wi�rn �� /'�l c�rS oF Zu <br />� t�15 i Ya f...l.. -1 0� �30Q. ( <br />PROPOSED USE OF BUILOINQ <br />CaM7�l�GC'Clft�- � 2� l <br />� D�ESC�R}I�PT�IO'�N OF Pf10PEfiTY 151i0WN BELOW <br />LUi � "_�/ OLOCK � OF_ <br />I�iVIS�Ot�I AI�- � . f�CG <br />L 5� U2Z <br />RALH TWO COPIES� <br />;\/C¢..1.4 1-11 LLS <br />Il�lli "iD �TN i <br />4. Ih , PCr7(�� <br />28 UO(c Ol"5 00 0�3 Od <br />iUCT10N LOM! LENOER, �ODfiE55. TELEPHONE NUMOER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET �TOILEn <br />BATHTU6 <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 �ISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />DHINKING FOUNTAIN <br />BACNFLOW PREVENTERS <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />FOR OFFICE USE ONLY: <br />FRONTSETOACR RERR SFTOALN <br />� ... <br />USE IONE M1EA <br />�•Z 2• C�e�d <br />HEIGHTUMITATION NOOFOWELLINC <br />UNIfS <br />���a� ,va <br />VANCY NOOiSIOWE$ OCWPANfLO�O <br />..�JP <br />SPRINKLEflR[O'D nFA50N <br />AINRMPEO'D REASON <br />EOi f,ONST PLMlSA '!)(IYED01 <br />r/w� <br />UAIE N 1�. <br />i <br />FEE <br />S <br />S <br />SIDE SETOACN <br />NA <br />VACRNI SIfE <br />❑YES �'NO <br />SREOFBLOGRI <br />❑vE5 ❑ ur <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />LOIITACf P[1150NFND PHONE NO . <br />( 201�) '-1 5 Ll ` `l�'l <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />_ WORK WILL DE COMPLIED WITH WHETHEP SPECIFIED NEREIN OR <br />NOT. 7HE GRANTiNG OF A PERMIT �OES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION OR Th1E <br />PERFORMANCE OF CONSTRUCT�ON. ThIAT I AM AUiHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />7'j APPLICATION IS MAOE AND I COMPLY WITH TNE STATE <br />,i CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />X \�,� M`C l� � `I /��1 /9� <br />SIGNAi11f1E DATE <br />O 23 5'3 `1 - <br />CITY BUSINESS LICENSC NO <br />NO. <br />OF EOUIPMENT <br />A/C — NFINDLG UNRS <br />FOHCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATEPS <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />GAS <br />rtaN ciiecK r+uunrn <br />OIIIID�NG <br />rwunwc <br />MFCII�NI��I <br />pDD� i IONRL f`LAN Cllf LR <br />on�[n <br />STAIE O111101NG 5�111CIu(iGE <br />rimiic xonKs <br />rorn� <br />FEE <br />SUB TOTAL S � <br />PERMIT S � <br />TOTALFEE S ' <br />reE � �� nECFirr uo <br />VALUATION FEE <br />iJ �; � . ; _�� : , <br />