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�—. <br />APPLICATIC J FOR CONSTRUC7 _ JN PERMIT <br />CITY Of EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVEREI7, WA 98201 • 259-8810 <br />[7 DEMOLITION fl COMBINATION �BUILDING f� MECHANICAL I�pLUMBING fl SIGN <br />PROJECT ADDRESS �. _. ii , • �. <br />MAILAODR55S • CITV ZIP PHONE <br />., ,(%�'��3H 2520 [,^«/� w°t Sti.�`B Lr.��wae.d l�`�6 /2G�) ?�7-67�� <br />TENANT <br />ARLHIfEO C� RDESIGNER MMLpAOURE55 ,1 �r ��.TM y,� ZCjFj�G J PHo<Z�r', J��OS� � <br />C.�11 il Lt�ICS � /�� /' `tGfl%i�s GvC/!�� /tJ <br />OENEMLCONTRALTOR MAILADDRESS CITY P PIIONE STATELICENSE� <br />�ilCc�irrv/c��i1Yl�-+-i i�'Zv U^�/�(��•�ie6 L`%��0^l.b� QBG�/6 �71�%7YI-67W CLE�TEG!/pON <br />.`AECHANICALCONTMCTOR AIL�DDRESS CIN ZIP PHONE STATELICENSE� <br />���f�c�� f+�iqK��z7�'"Zi2UG,-«1.,��.i�f�%f L�,n��,,u,�-�/%80Y6 � ZoGi7ts"J-67uo CLEc7EUl0ob{ <br />PLUMBINGCONTRACTOR RILAODRESS �/�/j ZIP $�yb PIIONE STATELICENSE/ <br />�(Ccfn � k� E.���.. �..-.-i Z.iiZo L�..� �, LeJa.� Sti, T� {i G�.tNWrx�/ �i / wb) �37-67� GC.E L7ELl l 0 d H <br />COY�RACT PRICE OF WORK �f� <br />x� StX�- O o <br />DESCCIBEMIORKAND UAREF L1GE�NV VED <br />�� %...1 i'., c .. n Y J��if <br />H M. I• . N C I I! <br />� � <br />P����lya�����/�� -�Y <br />LEGALDESCRI OFPPOPERTY(5 BELOWORAT�TA�C/J�� TWO QOPIES� <br />LOT'� BIOCK OF // ��L_ <br />PMCEL TAX I.D. NUMBER <br />CONSTRUCTION AN LENDER,AOIXIESS TEIEPNONE NUMBER <br />�✓�C�Gn�C <br />���rf�r�ktr �4� Br4-, S��i-��yE <br />PLUMBIN6 <br />NO. TYPE OF FlXTURE OR REM FEE <br />WATER CLOSET (TOILEn � �- <br />BATHTUB ; <br />LAVATORY (WASH BASIN) -T <br />SHOWER ' <br />KITCHEN SINK 8 DISP i <br />--r <br />DISHWASHER � <br />LAUNORYTRAV ; <br />CLOTHES WASHER � <br />URINAL i <br />DRINKINO FOUNTAIN i <br />FLOOR DRAIN � <br />BACKFLOW PREVENTERS � <br />SINK (SERVICE - BAR, ETC.) � <br />� <br />� <br />--r <br />� <br />i <br />� <br />SUB TOTAL S ; <br />PERMIT S � <br />TOTALFEE S ' <br />FOR OFFICE USE ONLY: <br />FRONT SETB�CN _ l REAR SETBACN _ � SIDE SETBI��(. / <br />%/[� �/ � <br />ZONE . �LOTARE� <br />dF�GMTLIMIT�TION NO.OFDWELUNG <br />/ UNIIS <br />OCCUPANCY NO Oi5fC1NE5 OCCUPANTLOAD <br />GNOU <br />o.� �.i 2 N/,� <br />OF <br />N I DRIE <br />V�CANT SITE <br />fIYE$ fl NO <br />f1 YE5 I�O <br />HEATING SYSTEM: I�(GAS f-1 ELECTRIC fl <br />-7�7 -6'7 OJ <br />I HEFEBY CERTIFV THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES 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 />OTHER STATE OR LOCAL LAW RE6ULF�TINO CONSTRUCTION OR THE <br />PERFORMANCE OF COfJSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA ORS LAW 7. RCW AND 296.200 WAC. <br />x l���t��llR�G/✓� tis�s'f ! /fY.� <br />SIGNA,URE DA{ <br />CITY BUSINESS LICENSE N0. <br />MECHANICAL <br />TYPE OF EGUIPMENT <br />A/C -A/HNDLO UNRS - H.P. <br />FORCED AIR SYSTEMS - B.LU. M E.A. <br />HEAT PUMP <br />UNIT HEATERS - B.T.V. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />WATER HEATER <br />WOOD STOVE <br />FIREPLACE INSE <br />GAS FIREPLACE <br />GAS PIPING <br />E%HAUSTFAN <br />BUIIDMG <br />+ PLUMBING <br />MECHFNICRL <br />ADUITIONRL RAN CHF.CN <br />OTMER <br />STqiE BUILOING SURCHRfiGE <br />CITY OF EVERETT ���81IC WORNS <br />LOCAL SALES <br />TAX CODE IS 3105 TO7A� <br />SUB TOTAL 3 <br />PERMIT 5 <br />TOTALFEE 3 <br />FEE � _ � RECEIPT NO. <br />FEE <br />a�� <br />C.r� <br />