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�1 '\ <br /> APPLIGATIG.�1 FOR CONSTRIlC7 .JN PERMIT <br /> CITY OF EVERETT• B:JiLDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION l�YBUILDING GYMECHANICAL �f PLUMBING ❑ SIGN <br /> PROJECT ADDRESS ,I /� <br /> �07 -�OCesG l..ou� <br /> ONMER MAILADDflESS CITV IIP PHONE <br /> G.,�1.2r7�v�7z-yL ���s /7��-5T L5'w ?�i71E[� , bb/ ? 7�2- L7S�� <br /> TENANT T� y�� n MAILADOHESS CITY 21P PMONE <br /> �/��'I-C� <br /> �RCHfiECTOR0E51GNER MRILAODRE55 / y �j��GJ�TIY EIP PHONE �,` <br /> GENEML�/ IA�ACTOR L�A�0�5 �i" ��7 41��C ryGrJ� �L lu� Gf/G�/✓ /��C��E LICE3'�S'.S�13G <br /> �m G L,��ultS✓r3�l� L,�-,�IvS c� o G�L63 <br /> MECHANICALCONIRACTOR MAILADDRESS CIN ZIP PHONE STATELICENSEII <br /> PLUMBINOCONiRACTOR MAILAUL`PESS CITY 21P PHONE STRTEUCENSE� <br /> CONTRACT PRICE OF 'Y <br /> _����f HEATING SYSTEM: f�GAS f7 ELECTRIC ❑ <br /> DE IBE Y/ORK AND SOUARE F TAGE IN� CT PERSON AND PHONE N <br /> /�/a!i/ /79�� <br /> �. �Z-Z 7� �� <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOF&IILDINd APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL . <br /> PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEOALDESCRIPTIONOFPROPERTY�SMOWNBI'JWORATTACNTWOLOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or �3 e�ocK oF_ AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> - OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> �, ` ' 4' PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORRED BY THE <br /> ' OWNER OF THIS PROPERTY T RFORM THE WORK FOR WHICH <br /> �' APPLICAT IS MADE COMPLY WITH THE STATE <br /> � vw+ce� '+. I.D.NUMBEfl CONTR T RS LAV�1827 ND 296.2 AC. <br /> � CONSTRUCiIONLOANIENDEfl,ADDRE53,TELEPHONENUMBER' '�� X / '�Al �Z/� � <br /> 51 ���� DATE <br /> � �N����/'�w� CITYBl1SINE S NSENO. <br /> � PLUM&NO MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF Fll(TURE OR REM FEE <br /> 5 WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. <br /> i <br /> ! Z BATHTUB � FORCED A�R SYSTEMS—B.T.U. M E.A. ' <br /> � <br /> �� LAVATORV(WASH BASIN) � HEAT PUMP � � <br /> �� SHOWER � UNITHEATERS—B.T.U. M ' <br /> � KITCHEN SINK&DISP ' i � CLOTHES DRYERS i <br /> � DISHWASHER � VENTILATION FAN � <br /> � LAUNDRY TFiAY ; RANGE HOOD i <br /> � CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � F�REPLACE INSERT(WOOD BURNING) � <br /> � BACKFLOW PREVENTERS � GAS FIREPLACE � <br /> SINK(SERV'CE—BAR,ETC.) � GAS RANGE � � <br /> ' GAS PIPING ' <br /> � EXHAUST FAN � <br /> �— <br /> � � <br /> i � <br /> i <br /> , � <br /> SUB TOTAL $ ; SUB TOTAL $ ; <br /> PERMIT $ � PERMIT $ i <br /> TOTALFEE 5 ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: 5da• 7 7 <br /> FROMSETB�CN 1 REARSE(BACN � SIDESETBA K 7 PLANCHECKNUMBER FEE RECEIPfNO. <br /> � � 5 O Si�77 <br /> usezor+e `I LOTAREA VACANTSITE FEES VALUATION FEE <br /> ��� nves ❑ No �� ��%� <br /> /•'� BUILOING <br /> HEIGHTIJMITATION�/g NO.OFDWELLING SIZE?F��G?I. � T <br /> � UNIT$ �JX P�UMPING ��(/ <br /> CUPANCY NOAfSyMIES OLCUPANTLOAO BA EME T i <br /> �P MECHRNICAL v <br /> � 1 ❑YE O � <br /> FIRE�LAR PEO'D REASIXJ ADDIiIONRLPLANCHECK 3 � 'JO <br /> � <br /> OTHEH � <br /> FIRE S R REQ'D REASON � <br /> STAIE BUILDING SURCHARGE I S� <br /> TVPEOF Si PUNSAPPROVE CRY OF EVERETT PIIBLIC WORNS au` ; OD <br /> v LOCALSALES � <br /> o�TE 6� TAX CODE IS 3105 TOTAL '3 �?b <br />