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APPL..ICAT1�"f+ti FOR CO�i1�TFi�sC�EOt+� PEE3MIT <br />CITY OF EVERETT • BUILDING DIVISION <br />320o CEDAR STREET • EVERETT, WA 98201 • 259-Br10 � <br />❑ DEMOLITION ❑ CO.NBINATION ❑ BUILDING �MECHANICAL CI PLUMJING ❑ SIGN <br />PROJECT �1�D�R� SS C��`��� � V El'�L� �.E� I� ��/ �Y <br />L) <br />I:IIY 1� <br />I � �Y <br />C�U <br />ZIP <br />/ <br />.t.a�: //� <br />-87�',9 <br />� `/�/ - 4 �1 /- 7` i t [ci .. . ,�r � - <br />GENEMLCONTRACTO� MAILADDI1C55 CIT7 7.IP PIIONE ST�TEUCENSE� ` <br />� 1�:1� <br />� MECHANICAICONIRnCTOR MAILAOD�E55 CITY ZIP PIIONE STA7ELICENSE� <br />VtICIUG� SP�2i�l(�f�.'�2 ,3434- �sr QVE s 5Ei4TfZ�= 9Bi� (�7z-4�5� VlK(dAS3�3W, <br />onwaiunmuinncmn unl�.M�BE95 CIfV ZIP PIIONE STAIELICENSEI <br />Corv�nncrrwceurwunR �,� ,J `�CL�S HEATI�vGSYSTEM: ❑GAS ❑ELECTRIC <br />OESCRIBE WOfiN ANO SOUARE FOOTr1GE INVOLVE� LONi�CI PE�SON AND PIIONE N0. <br />_.._..�r �.....,..i�.i c,.� ._J��tnn 1 dwl� 1 �1�l4�1'�G �i�.2- <br />�pT BLOCN <br />�pN57RUCTION LOA.'� IEREEO, AODRESS. TELEPMONE NUMBEfI <br />TYPE OF FI%TURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />SHOWER <br />DISP <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />SU� TOTAL S <br />PERMIT 5 <br />TOTALFEE $ <br />FEE <br />FOR OFFICE USE ONLY: <br />FRONT SETO�CK PE�N SETOAfY SIUE SETOACN <br />USEZONE <br />IIEIGIIT UNITATI00 <br />OCCUPANCY I N0.0( <br />Gt10UP <br />VIK1�J4 'SP�1►�1KL�.}Z - - <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO UE TRUE AND CORRECT. QLL <br />PROVISIONS OF LAW� AND ORDINANCES GOVERNING THIS TYPE OF <br />WOFK WILL BF COAIPLIED 1YITH WHETHER SPECIFIED HEREIN OR <br />NOT. TNE uRANTING OF A PERMIT DOES NOT PRESUME�tO GIVE <br />AUlHORITY TO VIOLATE OR CANCEL THE PRO,V.ISION OF ANY <br />OTIiER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF TIiIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MA AND I COMPLY WITH THE STATE <br />CONT (. ORS LAW 1. RCW AND 296.200 WAC. <br />X 3— ¢9 <br />SI RE D�iE <br />Q7Y IlU51nL55 UGLNSF NO � Z 4iO4 <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FE�_ <br />A/C — AMNDLG UNITS — H.P. ' <br />FORCED AIR SYSTEMS — B.T.U. M c.A. � <br />HEAT PUMP ' <br />UNIT HEATERS — B.T.U. M ' <br />CLOT. HES DRYERS � <br />i <br />VENTILATION FAN ' <br />RANGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLA( <br />FIREPLACE INSE <br />G�S FIREPLACE <br />GAS RIINCE <br />GAS PIPING <br />EXHAUSTF�N <br />SUBTOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />Pl/dlCHECKN�UM/QCEfi (/J fEE RECEIPTNO. <br />�7J�U — <br />LO7aREA VACnNiSIiE htC'_ <br />❑VES ❑ NO OC:LOING <br />NO. OF DWELUNG SIZE OF BLDGR.I. <br />UNITS PWMOING <br />OCCUPANiIOAD OASEMEN� p+ECHANICAL <br />❑vE5 ❑ NO <br />A�DITIO���L PLAN CIIECK <br />11EASON <br />O1HER <br />REASON <br />;�TNG �UILOING Sll(1GI/AfiGE <br />rtnr+sn qveoov CITYOFEVERETT ruoucwo��Ks <br />� , LOCALSALES <br />�1E '� '� y-`j 1 TAX CODE IS 3105 TOTAL _ <br />