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. . APPLICATIt,.� FOR CONSTRUC1 .dN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, Wq gg2p� .p59•8610 <br /> ❑ DEMOLITION f OMBINATION ��YBU�I.p�NG f7 MECHANICAL fl PLUMBING Cl SIGN <br /> PROJECT ADDRESS <br /> J� �l - - L E <- _._. <br /> OWNER MAILqDORESS <br /> 1 '� /� �]��ry pPHONE <br /> /��Vr' � � /� ��1f / 1C.�n� GM T� �/ nfl\ ��I �A1O14�OY"��SI`� 1O � 1O SIA � <br /> 1ENANT MRILADDRE55 6a i <br /> CITY 21P <br /> PIIONE <br /> ARCHITLCiOR�E5IGNER MAILADDRE55 <br /> S A��� Clry Z�P PHONE <br /> GENERA�CONTRACiOR MAILp00RE55 ��n, � � L.S <br /> z�P PIiONE STAiE LICENSE M <br /> MECHANICAICONTqACTOfi MAILpDORE55 <br /> CITV ZIP PHONE STATE IICENSE� <br /> PLUMBINQ�ONTRACTOR MqILpODRE55 <br /> ��TM Z�P PHONE SiATE LICENSE� <br /> CONiqACT PqICE OF WOfiK <br /> ��f �v� HEATING SYSTEM: FFGA3�❑ ELECTRIC ❑ <br /> OGSCRIBE WORK AN�SOUARE FOpTAGE INVO� <br /> CONTAC.IDFqgpp��yiyHONE NO. <br /> �" <br /> - �3�-- <br /> m� - - 6a <br /> s� J <br /> � dC��C o`�� p/�Q �J f✓ I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> aaovoseo use oF evaoinc - APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � LEGALOESCRIPTIDryOFPROPER7Y�5H01VNBELOWORATTACHTWOCOPIES) WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � ` NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � �ot e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> S������ � �F� � ' ` n�'�" PERFORMANCE OF CONSTRUCT ON.7H TG AM AUTHORIZED BY THE <br /> � D "� _O�O � O� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> I —�O APPLICATION M )AND 1 COMPLY WITH THE STATE <br /> PARCELTA%�,D.NUMBER CONTRACTO 1 2 �1 AND 296200 WAC. <br /> CONSTRUCTIONLORNLENOER,ADUqE55.TELEPHONENUMBER <br /> x <br /> SIGN URE DRTE <br /> � L <br /> CITY BUSINE55 LICENSE NO. <br /> PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM MECHANICAL <br /> FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> � WATERCLOSET(TOILET) / � AIC—A/HNDLGUNITS—H.P. <br /> BATHTUB , � <br /> � FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> � LAVATORY(WASH BASIN) ; / � HEAT PUMP � <br /> SHOWER � <br /> KITCHEN SINK 8 DISP � '' � UNI7 HEATERS—B.T.U. M i <br /> � CLOTHES DRYERS i� � <br /> � DISHWASHER � � � <br /> LAUNDRY TRAY VENTILATION FAN � <br /> CLOTHES WASHER i ' I RANGE HOOD — � <br /> URINAL ' WATER HEATER — � <br /> — ' WOOD STOVE , <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) <br /> FLOOR DRAIN i <br /> ' FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ' GAS FIREPLACE � <br /> � <br /> SINK(SEFVICE—BAR, ETC.) � <br /> � GASRANGE � <br /> ' GAS PIPING i <br /> � <br /> � EXHAUSTFAN / � <br /> � <br /> SUB TOTAL S � � <br /> � SUB TOTAL S � <br /> PERMIT S i PERMIT 5 <br /> TOTAIFEE g � TOTALFEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETE7ApK REAq SETDACK SIDE SETB�CN <br /> • � � � PLANCNECK M9ER FEE �` RECEIPTNO. <br /> a s /�' �a`��d /09 ��/— <br /> USE20NEl LOTAPEA VAC4NTSITE FEES VAWAT�ON J v <br /> — FEE <br /> f7YE5 ❑ NO BUILOING ,I T— <br /> NEIGHTLIMI7AT�pN NOOFDWEWNG SIZEOFBLDG?�. iS/1�� I0�/ T ��y � <br /> /Z Jl UNITS �� I <br /> O P IM IN� � <br /> �OUPANCV Np0i5TORIES OCCUPAN^TL/OAD BASEME � <br /> ' � � /�( � ❑IES �O MECHRNICAI /' I <br /> C.J <br /> FIRE PURM p$O'0 fiEA50N ADDITIONAI PLAN CHECK j <br /> /f� \i � \ - ' <br /> FIRE SPRINKIER REQfI REASON OTNER . / /y� ` <br /> U / <iL <br /> � STATE OIIILDING SURCNAqGE � f D <br /> TYPEOFCONST. PLANSAPPp0VE00Y <br /> CITY OF EVERETT vuoucwoRKs � <br /> v, r✓ �J �'` LOCAL SALES �"U� <br /> _ DAtE �� - �?•i`I TAX CODE IS 3105 TOTAL � (y Z � �Z- <br />