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3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOUTION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />PROJECT ADDRESS ��'c� <br />L yns s� EU.K�-�- mf�- wrt� �f�� wr�rs,r. �2oc� <br />ONRJER MAILADDRESS CITV ZIP PHONE <br />���%'4l T �e��n C�oro' iial 4.d Rv - ��f�/� - '�t�l/D� �ZOG - �2' <br />TENANT MAIL�ADDRE55 CIN ZIP PHONE � <br />SIGN <br />�` i a 2i 3. <br />DESCPIBE WORK ANO SOUAPE FCATAGE INVOLVE� <br />LOi <br />CITV <br />ZIP <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACTPEFSO4ANDPf{ONENO. / <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />oiNc PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />l�"� WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />'PROPERN�SHOWNBELOWORATTACHTIYOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />BLOCK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />%�/�_ ��-C PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY FORM THE WQRK FOR WHICH <br />APPLICATION IS MAD�� COMPLY WITH THE STATE <br />., CONTRACTORS LAyVI$�25 D 296200 WAC. <br />�.0�` 8io0/ /i�68 <br />LENDER.AOORESS.TEL[ HONE NUMBEfl <br />PLUMB:Nr <br />NC. TYPE OF FIXTURE OR ITEM <br />WATER I:LOSET (TOILET] <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TrIAY <br />CLOTHES WASHER <br />UFlINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK fSERVICE — BAR. ETC.1 <br />SUBTOTAL 5 <br />PERMIT S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR SET�ACN <br />USEZONE LOTAREA <br />HEIGHTLIMITATION NO.OFDWELIJNG <br />UNITS <br />OCCUPANCY I NO.OF STOPIES OCCU^ANT LOFO <br />GROUP <br />FIRE SPRINNLEH REO'D <br />TYPE OF CONST. <br />BY <br />0 <br />CITV BUSK7ESS�UCENSE NO. <br />MECHANICAL <br />FEE N0. TYPE OF FIXTURE OR ITEM <br />� A/C—AMNDLGUNITu—H.P. <br />; FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />i HEAT PUMP <br />� UNITHEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />� VENTILATION FAN <br />� R�,NGE HOOD <br />� WATER HEATER <br />' WOOD STOVE <br />i METAL FIREPLACE (WOOD BURNING) <br />� FIREPLACE �NSERT (WOOD BURNING) <br />; GAS FIREPLACE <br />� GAS RANGE <br />� GAS PIPIIJG <br />� EXHAUST FAN <br />ISIDr SETBACK <br />!ACANT SIiE <br />f/VES ❑ NO <br />PLANCHECN <br />BUILOING <br />512E OF BLW/LI. <br />PLUMBING <br />I ASEMENT MECHANICAL <br />❑YES ❑ NO <br />AD�ITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SUFCHARGE <br />CITY OF EVERETT PUBLIC WOFNS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUBTOTAL $ <br />PERMIT 5 <br />TOTALFEE S <br />FEE (J RECEIPTNO. <br />.�73`. <br />FEE <br />