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APPLI�A�'IOr� !'�OR CONSYRIDC�'►JN PERMIT <br />CITY OF EVERETf • BUILDING DIVISION <br />3200 CEDAR STR�ET • EVERETT, WA 98201 • 259-8010 <br />❑ DEMOLITION ❑ COMBINf�TION p BUILDING ❑ MECHhNI(:AL ❑ PLUMBING (� SIGN <br />PROJECTADDRE5S: �l�oii( �C��t'�i.� I w� .�L I<-IIoZ� [�ezc�tr�r.�f yyz�'3 <br />�"L i � c0.. 36 6 S 13 � tid ,�s s c= .�.;� �oo >/ o:h �c�.a � �f ' -- , . �a U <br />ownen ,/� u1u��ooness/� /�J� e�tt z�r r��or+e l�G <br />lE �N� �lT�� 1 `V/v<S^O�VJ! l �C�U � `s /�� ���ril'�IZ1W�VvL LnCVNE �� L�.�Y �l �Iiq �YG�l( <br />N� , <br />ARCHIIECT Ofi1OESIGNE <br />f\' �• <br />GENEMICON RaC7IXi <br />�t <br />MECHANICAL CONTRACT <br />Nr� <br />PLUTABING CONTR�CIDf <br />UESGRIBE <br />,/ lOT <br />1 — <br />rnnn nuune�o <br />MaL <br />SOl1ARE FOOYAGE INVOLVEO <br />BLOCK <br />Y. ���t33 �ro21 <br />CONSTPUCTION LOM! LENUER. �DDilESS. TELEPHONE NUMBEti <br />NO. TYPE OF FIXI URE OR ITEM <br />; WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYiRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ETC.I <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETOACN REAR SETBACK <br />USEZONE IOTAnEA <br />HEIGMTLIMITAiION NOOFDWELLING <br />UNIfS <br />OJCUPANCY NO Of5I0NE5 OCCUPANTLORD <br />REO'D 1 �EnSON <br />Rf ASON <br />w�� tu• I'INNE <br />� cirv -- im ' / �� ni�N� <br />i 3 c� �— gr�ti�. �� P r � S� <br />CITY ZIP PIIONE <br />�'�-Zlfer.ur,G1 a <br />C�fY 21P PIIONE <br />SfAIE LICENSE � <br />STATE LICENSE � <br />q z - <br />STATE UCENSE � <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />LONTAGT P[RSONAND PHONE NO <br />I HERE9Y CEF.TIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO OE TRUE AND COFflECT ALL <br />PAOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK W�LL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTIWG OF P. PERMIT DOES NOT PRESUME TO GI�E <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAI LAW REGULATING CONSTRVCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED �Y THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAf <br />. <br />Y I!' ���� '/ � �9-9� <br />�'��..%� ,� � ��� <br />$���.ti•r T � DATE � <br />p1Y BU E55 LICENSC NO. <br />MECHANICAL <br />FEE NO. TYPE OP EOUIPMEN7 FEE <br />'—T <br />' A/C—AMNDLG UNRS � <br />; FORCED AIR SYSTEMS ; <br />� I HEAT PUMP � <br />' i UNIT HEATERS � <br />� , CLOTHES ��3YERS ; <br />� R,4NGE HOOD � <br />� WATER HEATER � <br />i WOOD STOVE � <br />� MEfAL FIREPLACE (WOOD BURNING) � <br />i FIREPIACE INSERT M�OOD BURNING) ; <br />� GAS FIREPLACE � <br />; GASRANGE ; <br />SIDE SETB�CK <br />VALANi517E <br />❑YES ❑ NO <br />SUB TOTAL S <br />PERMIT S <br />rur�aieeKr+uuncn IF¢�/JC� Iner.rirrHo <br />��Y ; Z.� !1 Ji/ <br />OWLtlING <br />S�ZE OF OLWRI <br />PLIIMOING <br />BASEMENT MECl/�NICAL <br />OrES O NO <br />AODIIION\L PUN C��ECN <br />OiNEO <br />STA1E OUIl01NC Su0Cfu0GE <br />CITY OF EVERETT rimncwonKs <br />LOCALSALES <br />TAX CODE IS 3105 ToraL <br />0 <br />� <br />