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APP'LICATl��I FOR CONSTRUCT�ON PERM14 <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 • 259-8810 <br /> f� DEMOUTION �l COMBINATION f l BUILDING f-1 MECHANICAL r 1 PLUM3ING (1 SIGN <br /> PROJECT ADDRESS , J� / r � � <br /> ���-- .�-!J nt !� <br /> ONTER MAqqDDRE55 CITV ZIP PHON[ <br /> L+ lo r�l�} HAo1�h HS�b (eeo,��sl �„� r�ae+i vlar 4b'yo�, 3SH �3� 1 <br /> TENANT MNLAODRE55 CIiV ZIP p110NE <br /> (:viSis l�oss>��Pi St+��e✓5 �yYS I.o�..lo�.� �.'�a✓elt ,la� `�$dOj 3S �J3�) <br /> ARCHITECTORUESIGI R MAILADDRE55 CITV ]m PHONF <br /> GEBER�LGONTMCTOR MAILAD�RE55 CIlY ZIP PIIONE $T�T[LIC[NSEe <br /> �alie. Qu ld,,r� �yw ��W iun� o�v 1Y G��+:F} WQ 9Ydv3 3S3 233i S��T�6.i cS3ah <br /> MECNANICALCONTR4CTOR MaILADORE55 CITV ZIF PIIONE STATEUCF.NSE� <br /> PLUMBINGCONTRACTOR MAILADDRE55 Gltt ZIP PHONE STATELICENSE• <br /> GONTRqCT FRICE OF WOfiK <br /> '�Op `� HEATING SYSTEM: f l GAS rl ELECTRIC �1 <br /> OESCPIBE WORK AN�$OUARE FOOTAGE IYVOWED CONTACT PeB50N 4N�PIIONE N0. <br /> 'n II h�.e rx � �r< n �j� <br /> f ,.�,s �q 11 ra j2d1. ���t d=or <br /> I HEREBY CERI'IFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING APPLICATION AND KNOW TFIE SAME TO BE TRUE AND CORRECT ALL <br /> v.P����S NONS i� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYP�OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESGRIPTIONOFPROPERTV HOWNBFLOWORATfALHTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHEH STATE OR IOCAL LAW REGULATING 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 COMPLY WITH THE STATE <br /> PARCELTA%I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUCTIONLOPNLEN�ER.A�DRESS.TELEPNONENUMBER X / ��V `� � �y J(�) <br /> SIGNATURE OATE <br /> CITY�USME55 LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUftE ON ITEM FEE NO. TYPE OF EqUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B:i.U. M E.A. ' <br /> _ LAVATORY(WASH BASIN) � I1EAT PUMP , <br /> SHOWER � UNIT IIEATERS—B.T.U. M <br /> KITCHEN SINK&DISP i CLOTHES DP.YERS ; <br /> DISHWASHER � VENTILATION FAN i <br /> LAUNDRY TRAY � RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER I <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNLIIN ; AfETAL FIREPLACE(WOOD BURNING) ; <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; ;AS FIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE —T <br /> ; GAS PIPING <br /> � EKHAUSTFAN ; <br /> � , <br /> SUB TOTAL 5 SUB TOTAL $ <br /> PERMIT S � PERMIT S � <br /> TOTALFEE $ � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FiiONT SETAACN RE/.R SFTDACN SI�E SGTBACK P14N CIIECK NUMOF.R � FFP RECFIPi NO <br /> ro�� <br /> use Zone iotnaEa vacaNr sirE FEES VALUATION FEE <br /> I I YE$ f 1 NO pUIl01NG �C�7 � �L ;. . <br /> i <br /> HEIGYT LIMITATION NO OP�WELLING SIZE OF BLDGRI � <br /> UNITS PIUM(tING � <br /> i <br /> OCCUP[NCV NO OfStORiES OGCUPAN7L0/.D BASEMENT —i— <br /> GROUP MECN4NICAL � <br /> IIYES II NO — — <br /> FIRE ALFPM REO'p RfA50Y AOOIIIONAL PLAN CHF.CN <br /> OTHER � <br /> i�RF.SPRINKLERRF.O�f1 Pf�SO4 —. <br /> STF1E�l11IDMG5URGHMGE <,,- � <br /> rvveorr,oNsr atnNsarrnoveosv CITYOFEVERETT runiir.wonKs <br /> LOCAL SALES �-- <br /> onrE TAX CODE IS 3105 70TA1 <br />