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,r - <br />APPLICATI�►�n1 FOR CONSTRUC?.ON PERM17 <br />_ CITY OF EVERETT • BUILDING DIVISION �C�!TT <br />3200 CEDAR STREET • EVERETT, WA 98101 • 259-8810 <br />fl DEMOLITION fl COMBINATIQN f� BUILDING f 7 MECHANICAL fl PLUMBING f 1 SIGN <br />PROJECT ADDRESS <br />-S/. <br />�U � <br />cm zir rrwrve ZS - �- U� <br />�/ .SG J'' � ..S �f Ty/i�//� li1/l/%%-/9�l/E/i�%/ L(/�i <br />CIT'I ZIP PMONE � �� <br />CITY ]IP PNONF. � �"� / <br />i� � __ <br />LIiY <br />MECHANICALCONIqACTOR MAILAD�RE55 CITY 21P PIION[ StATEIICENSF� <br />OQUf�'/ SU/t� �5 <br />PLUMBINGCONiRaC70R MAILAODRE55 Qtt 21P pMONE STATELICE65E� <br />LONTR�CT PRICE OF WORK <br />H'tATING SYSTEM: f l GAS �LECTRIC fl <br />�SCPIBEWORK JD�pq� TpGEIN,ViOLVED ���� CON CTPERSONAN�PMONENO. <br />O <br />.�' L /. /` /(/ G _ f- —2 :7'iv'3 e <br />.Q•�.. i„!r ��o,i <br />BELOW IXi ATTpt;H <br />LOT _� ___ BLOCK <br />C � L1�- <br />PRRGELTAXID NUMP'^ <br />3a�aG o5� ��'9 DC <br />CONSTFUCTON LOPN LENOER. AD�RESS, TELEPHONE NUMBEP <br />PLUMBING <br />NO. <br />OF FI%TURE OR ITEM <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />— BAR, ETC.) <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETAACK PEAR SFID4CN SIDE <br />s' � ' � � 0 5 <br />USE 20NE <br />��� <br />NEIGIIT LIMITATION <br />2 <br />� <br />iJ <br />LOTARER � VFCANISItE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPL�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERN:NG THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OF <br />NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEi THE PROVISION OF ANY <br />OTHER STATE OR LOCAL 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 />CONTRAC�TORS LAW 1827 RCW AND 296200 WAC. <br />CITY EUSINESS LICENSE NC. <br />MECHANICAL <br />NO. 7YPE OF �EOUIPMENT <br />A/C — FVHNDLG UNITS — H.P. <br />FORCEDAIRSYSTEMS—B.T.U. M <br />HEAT PUMP <br />iEATERS—B.T.U. M <br />FAN <br />WATER HEATEH <br />WOOD STOVE <br />METALFIREPLACEI <br />FIREPLACE INSL aT <br />GAS FIAEPLACE <br />GAS RANGE <br />3AS PIPING <br />EXHAUST FAIJ <br />PLAN CHECK NUMpER <br />� J(��V �t1YE5 f i NO ppILDING <br />N0. OF DWELLING SIZE OF BLpGRC1 <br />UNIiS � Z�{�`L �+F LIV�A/� p�I1N01NC <br />OCCUPr1NTL040 BRtiEM�EN�T M[CHAAILFL <br />A IYTES II NO <br />REASOY pDDItIONAI PLAN CNGCK <br />OiNEfi <br />RF�cON <br />ST/TE B�ILOIYG SURCN411GE <br />PlANSAPPROVE�Y CITY OF EVERETT PUOLIf. WORKS <br />LOCALSALES <br />�ATe 3/,�/9� TAX CODE 1S 3105 707nL <br />SUBTOTAL 3 <br />PERMIT S <br />TOTAL FEE $ <br />_ I RECEIPT NO. <br />