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APPLICATriN FOF; CONSTRUC"'10�9 �ERMIT <br />CITY OF EVERETT • BUILDING DlVISION <br />3200 CEDAR STflEET • EVERETT, WA 98201 • 259-8810 � <br />� DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUId81NG ❑ SIG' <br />PROJECT ADDRESS / � � <br />�%�� � �U(/J.:�� % �J�'�''.`'`- (�� <br />OWNER � MAILAOORE55 GITY ZIP PHONE <br />TENANT <br />MI11lPWNt55 <br />OIIY <br />� <br />PLUMBINGCONTflACTOR MAILADDRE55 CI7V ZIP PHONE STATELICENSE/ <br />CONTFyCT PRICE OF WORK <br />-� � o� a, o0 o SEPF <br />DES�IBE KANDSOUA EFOOTAGEINVCLVED <br />?. Crn�u .�a l.��ss Wsa„'> ' <br />�CiS7lJ.1 C'C_� ��',cV,��MV1 i'-r11� � <br />=��.tL�.� S'i0✓1��--`�a�� <br />.�I �F/5)L;Y7_ 4T f-/ 1♦ i <br />�P O(�POSE��D �US�E� O�F,,BU�ILDpIN ���������./ <br />� `�7i7ldOdd/�11�L*1L{-�C.7aY'�YfGIC.Ei�i <br />LEGA'_ OE1S/CRIPTION OF PR1OTPERTY (SHOWN BELOY! Oq ARACH <br />L�r�.�4��ELOCK � �•Z9� QF��{ <br />'C� O� L�4ua�� ✓�0017'��nnl <br />��ial,d. QF Il)L� 2 •c�1n � Z•CK��2 <br />PARCELTAXI.D.NUMBER <br />CONSTqUCT70N LOAN LENDER, ADDRESS. TELEPMONE NUMBER <br />PLUMBING <br />NO. � <br />TYPE OF FIXTURE OR ITEM <br />CLOSET (TOILET) <br />LAVATORY (WASH B:;: <br />SHOWER <br />KITCHEN SINK & DISP <br />CLOTHES WASHER <br />FOUNTAIN <br />BACKFLONlPREVENTE <br />SINK (SchVICE — BAR, <br />� I HEATING SYSTEM: ❑ GAS ❑ ELECTRIC <br />CONTACT PERSON AND PHONE NO. " a�l�., <br />1 1 <br />ZVi6i /.l X' � � l �., n 0 a+ 4 <br />p T� ��L I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />iO�C4 �� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING TH�S TYPE OF <br />WORK WILL BE COMPLIED W1TH WHETHER SPECIFIED HEREIN OR <br />coP s� NOL THE GRANTING Oi� A ��ERMIT DOES NOT PRESUME TO GI� <br />AUTHORITY TO VIOLATE OF CANCEL THE PqOVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THc <br />OWNER OF THIS PROPERTY TO PEFFORM THE WORK FOR WHICH <br />, � APPLICATION IS MADE AND I COMPLY WITH THE STATc <br />CONT ACTORS lAW 1827 RCW AND 296200 WAC. <br />x � L9i <br />SIGNATUPE DA E <br />LITY 9USINE55 UCENSE NO. <br />FEE <br />PERMIT 5 � <br />TOTALFEE S _' <br />FOR OFFIGE iiSE ONLY: <br />FRONT SETBACK REAR SETBACK SIOE SETBACK <br />c� G � O <br />U53 ZONE LOTAREA VA�ANT SITE <br />�� - p ❑ YES �O <br />HEIGHTUMIj�TION NO.OFOWELGNG SREOFBLDGR.I. <br />u, � uNirs � � 6 1�� <br />- 1 <br />'UPANCY NO OF57 <br />7UP r. <br />;-2 L <br />E ALARM REO'0 <br />Yc s <br />E SPHINKLEH RE�'C <br />r�s <br />'E OF CONST. <br />I-F.R <br />FEn50N <br />��r-� <br />REASUN <br />Q <br />PV.NSAF4 V�E,,D�BY <br />�ATE � �'I y - S j <br />�'^'s-a�-s s <br />❑YES �NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />NO. TYPE OF FIXTURE OR ITEM FEE � <br />A/C—A/HNDLGUNITS—H.P. � � <br />FORCED AIR SYSTEMS — B.T.U. M E.A. ; <br />UN�T HEATERS — B.T.U. M � ; <br />Ci nrucc novccc � <br />T <br />Vi � <br />�_ <br />�_--��y-�—,------�__ � <br />/ �7q � �"��. -;— <br />w'�, ��Cu�tio.V � � <br />_ � T— <br />F � � G$J 3Sg .;— <br />� <br />G • Yo � <br />G /} ` <br />G ' <br />E � U � �_ <br />_ � F V � �— <br />� <br />� <br />_ � � <br />T <br />- 51{vu� b Ir�t �� l3ccti 3d� a � � <br />- � � /63T <br />�— <br />_ � i <br />PLAN <br />PLVM9111G <br />MECHrWICAL <br />ADUITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCMARGE <br />PUBLIC WORKS <br />TOTAL <br />FEE FECEIPTNO. <br />`���Di7l_ ��OlAj/t�_ /� <br />� <br />1 <br />