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APPLICATIOrI FOR CQNSTRUCT�JN PERMIT <br /> CITY GF EVERETT• BUILDING DIVISION <br /> 3209 CEDAR STREET• EVERETT, WA 98201 •259-8A70 <br /> �EMOLITION fl COMSINATION fl SUILDING (�1 MECHANICAL rl PLUMBING fl SIGN <br /> / <br /> PROJECT ADDRESS � ) / � �6 �y1 L��i�� <br /> ! <br /> L✓ ����tw� �� �I{7E5_noon/, �� ���»( 35�! c�uE��� nP`IcQaO 3 rr+oNe a1- �7 �- '/��lY�i <br /> IENANT MAILAODRF.55 CITV ZIP PHONE <br /> ARCHITFCTOROESIGNEP MAILAOOAE55 Cltt ZIP PHONE <br /> GENERALGONTRAC OR MRILADUiiESS Cliv 21f' PIIONE SIATELICBNSEv <br /> vwNE� <br /> MECNANICpLCONTRACTOR M4ILADDRESS CITY ZIP PHONE STATEII�ENSEr <br /> PIUMBINGCONTRACTOR MAILAUDRESS CITY ZIP PNONE STATEUGENSE� <br /> CONTRqCI PNICE OF WOPK <br /> HEATING SYSTEM: f i GAS fl ELECTRIC fl <br /> OESCRIBE WORN AND SOUARE FOOTAGE INVOLVEO CONTACT PFRSON AND PHONE NO. <br /> .� �'6t0 (J� G CGP � <br /> I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED TF11S <br /> PROPOSEO USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> FROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHEFi SPECIFIED HEREIN OR <br /> LEGALDESCRIPTIONOFPROPE5RN�SHO�WN��BE�LOW09ATTACHTW coPiesl NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT SO a. �-oTN QB'LOCK�1oK ��'��E �N� AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> C�p /,�j' ��}.-d,' �, PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> �� C/ � /� � L�._. U� APPLICATIO�! IS MADE ANO I COMPLY WITH THE STATE <br /> PARCELTA%I.D.NUMBER CONTRAC`TO LAW 1827 RCW AND 296200 WAC. <br /> CONSTRIICTIOW IOAN LEN�ER.AD�RESS.TEIEPHONE NUMBEF x '��/, ��(jG( ��._'�__� / G5� /O` �_ " ,� <br /> SIGNATURE OATE <br /> CITY 9USINE55�ICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. 'fVPE OF FI%TURE OR ITEM FEE N0. 7YPE OF E�UIPMENT FEE <br /> � WATER CLOSET(TOILET) A/C MHNDLG UNRS—H.P. ' <br /> BATHT � ; FOR ED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY( ASH BASIN) i HEAT UMP � <br /> SHOWF_R � UNIT HE TERS—B.T.U. M <br /> KITCHEN SINK 8 ISP � CLOTHES YERS � <br /> DISHWASHER � VENTILATION AN —�— <br /> LAUNDRY TRAV ; RANGE HOOD ; <br /> CIOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN � METAL FIREPLACE(W BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(W BURNING) � <br /> BAC:KFLOW PFEVENTERS � GAS FIREPLACE � <br /> SINIC(SERVICE—BAR, ETC.) � GAS RANGE � <br /> ; GAS PIPING _ _ ' <br /> i EXHAUST FAN i <br /> � � <br /> � � <br /> � <br /> � � <br /> SUB TOTAL S SUB TOTAL 5 ; <br /> PERMIT S � PERMIT $ � <br /> TOTALFEE $ � TOTALFEE S i_ <br /> FOR OFFICE USE ONLY: <br /> FPONTSFT[fACK RE�q5F.T8ACN SIOESETBALN PlANC11ECKNUM9F.R FEE AFCEIPTNO <br /> usezoNe ioran�a VAGANi51iE FEES VALUATION FEE <br /> f1YE5 I1 NO T— <br /> pUILD'�NG � <br /> ___ � <br /> HEIGHi IIMITATION NO.OF pWELIING SIZE OF pL�GRI <br /> UNIT$ P�IIMOING <br /> —T <br /> OnOUPANCY NO 04 Si00iE5 OCCUPANi LOAO BASEMENT MECIII�NICAL i <br /> fIYES Il NO i <br /> FIqE AIARM REQD �fA50N ADUpION�I PLAN G��ECN i <br /> —�i—_ <br /> i <br /> OTHE{i � <br /> FlRF S�RINKIEil RE�70 RF�SON <br /> ST�TE OUIl01NC,SURCHMGE � <br /> r— <br /> TYPEOfCON$i PL�NSAPP�OVEDUV CITYOFEVERETT �IlAlif.\40RN5 ' <br /> I <br /> LOCAL SALES — � <br /> ��p�E TAX CODE IS 3105 TOTAI <br />