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APE�LICA�'10. � FOFt CONST�UCTI .�N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />C3` DEMOLITION ❑ COMBINATION ❑ BUILpING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: ��%CJ I C� J<'./q rC'(' �_L(�-u� � ��� � I �Ui' � <br />���ial< R� `1 t--C�l��a�ePn �,Jaa, c�,f . �.�rn .�S�cnl -�U�-t„�,Sq <br />h� ,. � � � ���. ��no�,E <br />5� �'i v1��I P GS.t.ZP �iXib� /��/3 ��3 oC7 <br />noon[ss -atv vm <br />MECHANICA�CONTRACTOR MAILADDRE55 Litt 21P PIIDNE SUTEUCENSE/ <br />PLUMBINGCONTR�CTOP AIAILADORE55 CItV 11P PIIONE SiAiELICENSEi <br />Pf110E OF WpRK <br />WORN <br />wi <br />BLOCK <br />�^nIQ u� .� <br />COPIE57 <br />PMCEL TAX I.D. NUMBER <br />CONSTRUCTION LONI IENDEN, ADORE55. TELEPHONE NIIMOER <br />PLUMBING <br />I:U. TYPE OF F�XTURE OR ITEM FEE <br />WATER CLOSET (TOILET) --� <br />�� J <br />BA7HTUB � <br />LAVATORY(WASH BASIN) , <br />SHOWER � <br />KITCHEN SINK & DISP � <br />DISHWASHF.R —' <br />LAUNDRYTRAY ; <br />CLOTHES WASHER � <br />URINAL � <br />DRINKING FOUNTAIN ; <br />FLOOR DRAIN � <br />BACKFLOW PREVENTERS ; <br />SINK (SERVICE — BAR. ETC.) � <br />FOR OFFICE USE ONLY: <br />FFONTSEiB�CK FEAR SF.TBACK <br />USE20NE <br />HEIGHT LIMIiATION <br />OCGUPANCY NO 0� SIONIES <br />GROUP <br />FIRE SPRINKLER flE0'D <br />FlPEAWIM pE0'D <br />TYCE r1F f.ONST <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />�ONiACT PERSON AND PNONE N¢� _ � � <br />I HEREBY CERTIFY THAT I HAVE READ AND ExAMINED THIS <br />APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF IAWS AND OR��NANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTlIER STATE OR LOCAL LAW REGULATIN� CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUC710N. THAT I AM AVTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PEFlFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />g �i/,7l'iiLl'11y� �(-� ��GG���, �.�. ,��` �!/ <br />SIGNATURE DATE �y—�Y� �� <br />D��7 .s� <br />CITY BUSINE55 LICENSC NO <br />NO. TYPEOFEQUIPMENT FEE <br />A/C — A/HNDLG UNfTS <br />FORCED AIF SYSTE�AS <br />HEAT PUMP <br />UNIT HEATERS <br />SUB TOTAL S ; <br />PERMIT 9 i <br />TOTALFEE 5 � <br />SIOESET6ACr n��N <br />IOiAAEA <br />NO OFOWELIING <br />UNIfS <br />OCCUP�NIIOAp <br />REASON <br />RERSON <br />PLAN$ APPBOVEO BY <br />Dn1E <br />CLOTHES DRYERS <br />RANGEHOOD <br />WOOD STOVE <br />FIREPLACE <br />I ❑YE$ ❑ NO pUIL01N(: <br />SRE OP BLDGrtI <br />PLUMOING <br />BASEMENT MECH�NICAL <br />❑YES O NO <br />AODIiIONRL PLAN C�1F.LN <br />0711En <br />S1AlE OUIlUINO SIIRG11AfiGE <br />CITY OF EVERETT �unnr, w•onres <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />FEF <br />PERMIT S <br />TOTAL FEE S <br />RECEIPT NO <br />