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APPLICATIC^ 1 FOR CONSTRUC7��N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CF.DAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION �COMBINA710�J rP( BUILDING ❑ MECHAN�C,AL .��PLUM�ING fl SIGN <br />PROJECT ADDRESS /, /D ,� S� �'l� /�,' ,�iL( �Y <br />G <br />OWNER MAILAD09ESS CITY1 zia rno,ve.-� <br />;�f4N« /�ss, Cfo (���sn�-c/Lluu�'«Pti� r�a S���C(fM4c( u�a , t-��-C I,U A- 48�,— <br />TENAN MAILADORE55 ��T�' ZIP OVE • <br />�� ��� SR��� ��Pr� M�<<, sP4<< �, � ���� �t �� k wF �,��� u�� �� <br />ARCHITEC— TOA�ESIGN MAILA R°55 CITY ZIP FHONE <br />��Co�vto►' Ay,occ��c5 !47 tinc�, �kcr �yiH6�i��'e.-�h�4-�c(� �JJ�- 48(!U(�0�8`Ea'S�f <br />�v �R�l(✓l� ncrpa�""`711�'vl fs ?'7 �!—I a`� �P�C L4 I1t S'�e"L��� PHONE 5rnre �d- NB �.Dr�lo63k <br />N , WA�R7-s8 388-�3; u <br />MECHANILAL ONTflACTOR MAIL ACDRE55 . CITY ZIP Pt10NE STATE LICENSE � <br />PLUMBIN�CONiRaCTOR kAILAUDHE55 <br />����(��G����o _ <br />LONTRACT PflICE OF WOR% <br />20, oc� <br />DESCRIBEW�O.RKJ:\N—DSOUAflEFOOTA.G[5 INVOWEO r <br />�C�M�tOG�E'� E'�(,5(-[�fil�' ���1� i� TJL <br />(U%4S7�nPO��I CCX�I/,�L' �O. C"� C"��� <br />— e oc4 ir �,,�.t% i— Vl e� Cu 6�S� <br />PROPOS USE FBUILDIN <br />r�; % �'4�cS o o✓� aM � <br />LOT' BLOCK <br />Ce <br />LENDER, ADDiiE55. TELEPHONE NUMBER <br />NO. TYPE OF FlXTURE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & i:tSP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN �e <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />/ CINKlCFRVIf:F—RAR FT <br />�e <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN REAR SETDRCK <br />USEiONE LOTAREA <br />HEIGIITLIMITATION NO.OFDWEILING <br />UNIT$ <br />r <br />SPRINKLER REO'� <br />y� <br />O� f,ONST <br />� <br />� <br />ZIP , PHONE STATE LIGENSE � <br />HEATING SYSTEM: Cl GAS C7 ELECTRIC fl <br />CONTACT PERSON ANL' PHONE NO. <br />� y I HEREBY CcRTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KP10W THE SAME TO BE TRUE AND CORRECT. ALL <br />�J (C� S PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILI BE COMPLIE.0 Y�ITH WHETHER SPECIFIED HEREIN OR <br />�S� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING GONSTRUCTION OR THE <br />� PERFOPMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED B'! THE <br />OWNEH OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />. APPLICATION IS MADE A61D I COMPLY WITH THE STATE <br />CONTRA TORS LAW 78.27 RCW AND 296200 WAC. <br />x �Nw /o�l!l�S <br />SIGNATUflE DA7E <br />CITV BUSINE55 LICENSE NO. <br />MECHANICAL 5 vt <br />FEE NO. TYPE OF EOUIPMENT FEE <br />� A/C—NHNDLGUNRS—H.P. ' <br />; FORCED AIR SYSTEMS — B.T.U. M E.A. ; <br />� HEAT PUMP � <br />�1 <br />� UNIT HEATERS — B.T.U. M ' <br />i CLOTHES DRYERS i <br />� VENTILATION FAN ' <br />' RANGEHOOD i <br />� <br />i WATER HEATER � <br />� WOOD STOVE - ' <br />i METAL FIREPLACE (WOOD BURNING) i <br />� FIREPLACE INSEflT (WOOD BURNING) ' <br />; GAS FIREPLACE � <br />� GASRANGE � <br />' GAS PIPING ' <br />� EXHAUSTFAN � <br />SiDE SETBaCR <br />VACANT SITE <br />1N <br />SUBTOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />PLAN CIIECK NUMBER fEE/ /�j RELEIPT ND. <br />�7� � .-CJ <br />FFFS VALl1ATION FEE <br />fIYES I O BWL�ING <br />SIZE OF BLUG?.I. <br />'��T / PlUM81NG <br />! ( <br />BASEMENT MECIIANICAL <br />flYES ilrNO <br />AOOITION�L PLAN C��F.CN <br />`✓%'/ 1 ��' I OTHER <br />STATE DUILOIHG SURCHARGE <br />CITY OF EVERETT rueuc wonKs <br />LOCALSALES <br />TAX CODE IS 3105 7oTAL <br />