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/1�22c> >% , - � � ,�. �l-�/� �. 9�0.�.3 �2�- y'��b <br />�4PRLI�ATII..� FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•E810 <br />I l DEMOLITION fl COMBINATION f l BUILDING fl MECHANICAL 1-1 PLUMBING fl SIGN <br />PROJECT ADDRESS <br />7�_�O � U P/' c!' C' � '�A ��P� P'f(� C<%d c�, <br />M � e Pe � <br />T NANT <br />AqCH�TECT OR OESIGNER <br />Ci-(e� /3�rfil <br />GENERALLONTRFCTOR <br />f�A�e /l�oe <br />MECHANICALCONTRACTOR <br />PLUMBING CONIRACTOR <br />CONTRACT PRICE OF WO(jlfr <br />it <br />OESCR�BE WORN AND S�l1Al <br />� N s7- s �E <br />ues i <br />LOT BLOCK <br />Mni�noor+ess <br />2IIX R;�ers���e <br />cirv �7m <br />UPlnlo�/ `� <br />GITV ZIP <br />MNLAODRGSS GITY <br />IS�6`6 Stiee oos�n C.AC����F <br />u <br />GITV ZIP <br />L.,_ , , �o <br />N <br />CONSTRUCTION LOAN LENOE0. FDORESS, TELEPHONE NUM�ER <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILETI <br />LAVA`ORY(WASH BAf <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />CLOTHES WASHER <br />URINAL <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — 6AR. ET <br />FEE <br />SU8 TOTAL S <br />PERMIT 3 <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FFI�NTSETBACK REAR `SETOA�K <br />� / d <br />USEZONE � LOTAREA <br />HEIGIITIIMITATION �. NO.OFDWELL�ING <br />� ' UNITS � <br />OCCUPANCY NO OFSi0RIE5 OCCUPANTLOA� <br />GROIIP <br />t�2.- I r�. �� , <br />A70 <br />PIRE SPflINNLERliEC <br />oFcoNsr r�nNsav aoveoev <br />77N �`'� t /, <br />SI�F SET�ACR <br />0 <br />ZIP <br />rr�or�� <br />_`P a k GGGa <br />PIIONE <br />PHONE <br />{GG �3�8� <br />PHONE STATE <br />�24 `�3`l� Ofl <br />PHONE STATE <br />N <br />� <br />PNONE STATE LICENSE a <br />HEATING SYSTEM: Cl GAS ❑ ELECTRIC ❑ <br />WNTACT PEPSON PNONE H0. <br />� ,� � �o . />i i _ �i„ G"/_ <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIOIJS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHi'R SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVt <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE 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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X 'V�i.JC_ �� ��J� � (.� <br />SIGNATURE DATE <br />CITY BUSMESS LICENSE N0. <br />MECHANICAL <br />NO. TY?E OF FI%TURE OR ITEM FEE <br />A/C — AMNDLG UNITS — H.P. i <br />FORCED AIR SYSTEMS — B.T.U. M E.A. ; <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE i <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GaS RA�GE <br />GAS PIPING <br />EXHAUSTFAN <br />PIANCHECKyU�A�ER . _-. I FEE <br />vnCnNi srtE / FEES <br />❑YES ',I NO Bl/1LDING <br />SIZE OF 6LDGRI <br />6�� ��pnr PLUM�ING <br />�FSEMENT MEGN�NICAL <br />jZ� nves 1�(No <br />AODITION4L PLAN CNECK <br />OTI{ER <br />STATE 9UILDING SURCH�RGE <br />CITY OF EVERETT PUALIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 70TAL <br />SUB TOTAL 5 <br />PERMIT 5 <br />. <br />