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� <br /> APPLlCATIG _J FOR CONSTRUC7 .JN PERMIT � <br /> ' CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMULITION f-1 COMBINATION �I'BUILDING fl MECHANICAL �� PLUMBING fl SIGN <br /> PROJECT ADDRESS �/ / � '/ / <br /> � 7 /b ��/I O cirr vv p `ziv CHONE <br /> OWNER M�ILAODRE55 <br /> r� <br /> �! ��, Ga N�., �7 S /00���/ E t-'��irr� y'���"r 3�� .Z//�/ <br /> TENANT MAl1,ADORE55 Cltt ZIP PHONE <br /> s�r� n1,�Q 3 �y s�s�'r <br /> �RCNITECT OR OESIGNER MAIL�OORE55 qTY ZIP PMONE <br /> OENER�L CONTR��TOR M�ILAO�RE55 CITY ZIP PIIONE STATE LICENSE� <br /> Dt,UNE)2 . <br /> MECHANICM CONTRRCTOR _/.,.MAIL/ADDRE55 CITV ZIP PNONE I/ STATE LICENSE� <br /> �f/CrGTPf?N 1 / f.C/�F/ M1I�GI '�S^.� �3 ��Y <br /> PLUMBINO CO R�CTOR M�IL ADDRESS CITV jlP PHONE r $iATE LICENSE• <br /> "�...� � F � J <br /> CONTMC ICE OF WORK <br /> HEATING SYSTEM: JXGAS f7 ELECTRIC fl <br /> DESCRIBE RKANOSOU�RE OOTAGEINVOIVED CONTACTPEflSONANDPHONENO. <br /> � rr H <br /> I HEREBY CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSEDUSE OF BUILOINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNINCa THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEHEIN OR <br /> LE6A�DESCRIPTIONOFPROPERTY�SHOWNBELOWORARACHTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT e�acK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF qNY <br /> OTHER STATE OR LOCAL LAW REQULATIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMP_Y WITH THE STATE <br /> PMCEL TA%I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296.20(�WAC. <br /> CONSTRUCT10NlOANLENDER.ADURESS.TELEPHONENUMBER X _ � <br /> N URE DATE <br /> 1 BUSINESS LICENSE NO. � <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASI��) � HEAT PUMP , <br /> SHOWER � UNITHEATERS—B.T.U. M <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRYTRAY ; RAN4EHOOD ' <br /> CLOTHES WASHER � WATER HEATFR , <br /> URINAL � WOOD STOVE � <br /> DRINKINO FOUNTAIN i METAL FIREPLACE(WOOD BURNING) <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFIOW PREVENTERS ; GASFIREPLACE ; <br /> SINK(SERVICE—BAR. ETC.) � GAS RANGE � <br /> ' GAS PIPINO ' <br /> � ExHAUST FAN / � <br /> � � <br /> SUBTOTAL E ; SU6�TOTA 3 ; <br /> PERMIT 5 � "' PE MIT / S � <br /> TOTALFEE S � TO l E� S � <br /> FOR OFFICE USE ONLY: ��.�D .9 - - . <br /> FRONT SETBACN RE�R SETBACN SIUE SETB�CN PIAN CNECN NUMBER EE - � AECEIP�HO � � <br /> � � S �ci ,C� I. � 3 d'�' <br /> USE ZONE(� IOTAR/EA VAC�NI 5 7E FEES VA ATION FE , <br /> 1� Z 1��. YES fi NO OOIIDING r 7� 27� <br /> IIEI6NTLIMITATION NOOFUWELLING 512EOFBLOG?I � <br /> 2 UNITS S �.F• N/1�L PWMOING � <br /> � O J.F. ARAGE+ <br /> OCCUPANCY NOOiSfORiFS OCCUPANTL0�0 B�SEMENT }— <br /> GROOP � MELNANIC�L � <br /> .3 v• q nres <br /> FIRE ALARM REO-D HE�50Y ADOIIION�L PL4N CNECN � i!/' <br /> 7_( <br /> OTNER � <br /> FIRESPRINNIERREO'0 REASON - <br /> ST�IE OUILDING SURCM�RGE ,�T/� <br /> iYPEOFf,ONST PL�NSAPPRpyED,OY •t�LJ <br /> � 11_ CITY OF EVERETT runucwonKs �; _ <br /> ..�}� V�� LOCAL SALES , --�� <br /> L onrE z. TAX CODE IS 3105 TOTAI � I� <br />