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APPLICATII.d FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />❑ DEMOLITION �COMBINATION �] BUILDING ❑ MECHANICAL r7 PLUMBING fl SIGN <br />PROJECT ADDRESS <br />l�On�? til A6N0UA f1VE • I <br />Mts D V <br />s106 rs � VS� scJ ��9M0.�/9s'"V9ffa�� �'y3 ��17b <br />TENANT a� MAILA�DRE55 CITY ZIP PNONE <br />U/iC A�� � <br />ARCNRECTOROESIGNEP MFILADORESS CITY ZIP PHOKE <br />GENEFALCONiRACTOR MAILqODRE55 CIN 21P pHONE STATELICENSEI <br />AIECHANICALCONTqACTOR MAILADDRESS CIN ZIP PHONE STATELICENSE� <br />PLUMBINGCONiRACTOR MAILADDRE55 CITY 21P PHONE STATELICENSEY <br />0.GT PRICE OF WORK <br />Nas S�'�- �er <br />y�� �FTt�L �� Fi,�e- _ <br />A SCZatip S� cy o/'� � A �St <br />►3 v� c o �,��� F��� �q vr rY FLv uJ Si0 � Sru/c�'� <br />PFOPCSED U$E OF BUILOING <br />�K( �E'nlCt <br />LEGRL DESCRIPTION OF PpOPERTY (SHOWN 9ELOW OR ATfACN TWO COPIES) <br />LOT BLOCK oF <br />r���r�,�� �M�'l�y -y -Olb - �c)v`i <br />CONSTAUCTIONLOANLEN�ER,ADDRESS.TELEPHONE NUMBEF <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WAT�R CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />RINKlSFRVICF—RAR FTC1 <br />HEATING SVSTEM: ❑ GAS �(ELECTRIC ❑ <br />CONTACT PERSON AND PIIONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANU CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL 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 � HIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE ND I COMPLY WITH THE STATE <br />C CTORS LAW R AN 6.200 WAC. <br />v� �p �ZT �� y <br />NATUj1L'� � , _ - ^ � 0 TE <br />l..l(,<l 7'15��` <br />CI i V BUSINESS LICC"^E NO. <br />MECHANICAL <br />FEE � NO. � TVPE OF FIXTURE OR ITEM <br />! � A/C—A/HNDLGUNITS—H.P. <br />; FORCEDAIRSYSTEMS—B.T.U. M <br />i HEAT PUMP <br />SUBTOTAL 5 <br />PERMIT S <br />I TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN REAR SETBACN SI�ESETBACK <br />USEZONE LOTAREA VACANi51TE <br />f]YES ❑ NO <br />HEIGHTLIMITATION NO.OFDWELLING SREOFBLDG/TI. <br />UNI75 <br />❑YES ❑ NO <br />— B.T.U. M <br />VENTILATION FAN <br />FiANGE HOOD <br />WATER HEATER <br />WOO� STOVE <br />GASRANGE <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />PLAN ClIELK NUMOER � FEE I RECEIPT N0. <br />BUILOING <br />PWMBING <br />MELN4NICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHAPGE <br />PLANSAPPFOVED9Y CITYOFEVERETT PUBLICWOPKS <br />LOCALSALES <br />nnco TAX CODE IS 3105 70TAL <br />