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APPLICATIVN FOR CONSTRUCT�ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVEAETT, Wq g8201 • 259-8810 <br />❑ DEMOLITION �l COMBINATION I-1 BUILDING f1 MECHANICAL r� pLUMBING fl SIGN <br />PROJECT ADDRESS <br />�3�� /�,��1 s n,ti <br />� ' ��% ZIP 'j' y `�( • PNONE !� 7/ <br />TENANT � �It���Y ���-� i•/�DIJ�� SI �� ��1y6� �SS—�/J� <br />MqIL Ap RESS ��n, E��P I <br />Z�P c`MONE " <br />ARCHRFCT pq pESIGNER MRII. ApORE55 <br />��TY IIP PNONE <br />PWMBINGCONiRACTOR MM1ILA�ORESS <br />��ry Z�P PNONE <br />SiATE LILENSE + <br />DESCRIBE WORK aN0 SOVARE FOOTqGE INVOLVED <br />�=an� veo�nirllON OF PqOPERTY �SHOWN BELOW OR <br />LOT� BLOCK — nc <br />CONSiHUCT10N LOAN LENDER, ADORESS. TELEPNONE NIIMOER <br />PLUMBING <br />Na• TYPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVqTORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />OISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASFIER � <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — Bna FTr. � <br />SUB TOTAL 5 <br />PERMIT g <br />TOTAL FEE 8 <br />FOR OFFI�E USE ONLY: <br />FRONTSETPACN REAR SF.TOACK <br />� <br />USEZONE �OTAflEq <br />IIEIGHiLIMRATION NOOFpWf.LING <br />UNIf'j � <br />/� / <br />OCGUPANCI' NO 0[Si0RiE5 OCCUPANTL AD <br />GRO��1P,�� f <br />FIRE AIARM R[O'D REASON <br />FIRF GPqIN I. R RFOO RE�SON <br />7VPEOFf,ONSt Pl�NSAPPR <br />`L /V f1FTE � <br />HEATING SYSTEM: Cl GAS �l ELECTRIC �l <br />CONTqCT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT i HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WIIL BE COMPLIED WITH WHETHEFi SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE FROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIOP! OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND � COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RC AND 296.200 WAC. <br />x � r� � �- ��7��� � l� �- ao� %s <br />SIGN URE pAT <br />dTY BUSINESS LICENSE Np. <br />NO. I TVpE OF EQUIPMEN7 F8E <br />SIDE S-T�ACK Pl6N CIIF <br />! <br />VFCRNi SITE "�� � <br />fIYES �ncp <br />BUIIDMG <br />S2E OF BIffiT <br />`v� — wnrvuu; UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M E A <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLUTHES �RVERS <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE fWnnn ai iauinir_� <br />FIREPLACE INSERT (WOOD BURNItJG) —I ---i -- <br />GAS FIREPLACF � <br />GAS PIPING <br />EXHAUST FAN <br />W/ � � PIUMAING <br />� ). <br />dMENT MECH�NI[Al <br />IIVES � <br />ADD�IIONAI. PIAN GNf:CK <br />OiHEl1 <br />ST/.lE BUIIOMG SURCNnRGE <br />CITY OF EVERETT �UBI IC W09KS <br />LOCALSALES <br />TAX CODE IS 3105 70TAL <br />SUCi TOTAL S <br />PERMIT $ <br />TOTAL FEE 5 <br />'EF REC[IPTNO <br />��'�'� ' � <br />