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APF�LICATIG�nI FOR CO�NST'RUC� .,OM PERMI'T <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET • EVERETT, WA 98201 •2F3-8810 <br /> DEMOLITION f I COMBINATION f� BUILDING �1 MECHANICAL I� PLUMBING rl SIGN <br /> PROJECT ADDRESS I <br /> I� j� t�^i O �/�� �lJ rc✓��� <br /> ONMER MAILADDH[55 � CITV . FNpNE <br /> �iu�s N�.I.A•`��Gt P�ex53�b EvFr�tF YS,:'oF• `5�-�'72E <br /> TENANT MAILR�CPESS CITY 2:P PHONE <br /> ARCNITECiOR0E51GNEfi ldAILADDRE55 CITY ZIP PHONE <br /> GENERAICONTRAC'OR MAILApDRE55 CITY ZIP PHOhE STATELICENSE� <br /> MECHANICALCONiPFCTOR A1AIL4DDRE55 CITY ZIP PHONE STATELICENSE� <br /> PLUMBING CONTPACiOR MAILAO�RE55 CIN ZIP PHONE �TAiE UGENSE x <br /> CO��TRAGT PRICE OF WORK <br /> HEATING SYST[PA: ❑ GAS f-1 EI.ECTRIC ❑ <br /> DESCRIBE WORK AND S�l1ARE FOOT GE LVVOLVEO GONTnCT PERSON AhD PHGUE N0. <br /> G1a.�c h 5!, ,-� ��� o� a����r r La:�2.r �..�s M. � /._ - �S Z-z 72 L-. <br /> r�vl(�Cf.W�EH-I' ' !J- rJK-1- _�_ _ <br /> T <br /> I HER'cBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APFLICA�ION ANO KNON�TFIE SAME TO BE TFUE AND CORRECT.ALL <br /> PHOPOSED USE OF BUILDING PROVISIONS OF LAWS AND ORDItJANCES GOVERNING THIS TYPE OF <br /> � WORK WILL BE COMPLIED WITII WHETHER £�E�IFIED HEREIN OR <br /> �Gn� i io P N r+ e v o a i� o�` � NOT. THE GRANTING OF A PERMIT DCES N07 PRESUME TO GIVE <br /> �- 4�' F'��'"�`��"�''��-�� `�'`��� � ; <br /> �ot BLOCN � /i � jo v� AUTHORITY TO VIOLATE OR CANCEL TF E PROVISION OF ANY <br /> t /' qp OTHER STATE OR LOCAL LAW REGULATING CCNSTRUCTION OR THE <br /> �p IpCcCikfO{ t174.Y2rJ d�SP�(�Ir�}- �fi�ofNF-[Y �NUpIuu�' PERFORMANCcOFCONSTRUCTION.THAT�PMAUTHORIZEDBYTHE <br /> 3 p� PI�i-5 pa,yF�p� P.4�cr � o�S�e ub iuIS4 r 4N� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WFIICH <br /> < � Y APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � � - A � i � ( ��' ��..7<G Sddlr n� � <br /> ARCELTA%I a �� tCONTRACTOR W 18.27 9C W AND 2962U0 WAC. <br /> L1(��i(..,- Zc�. � " ()O� � '� _ ��� G�arcG t- 1 L <br /> CONSiFOCTION LOR � �ER.ADDRESS.TELEPHONE NUMBER X e t.�'A ��� f I� <br /> SIGNaTURE DATE <br /> QTY BUSINE55 LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF FIXTURE OR ITEM FEE <br /> WATE OSET(TOILET) � A/C—NHNDLGUNITS—H.P. ' <br /> BATHTUB ' FORCEDAIRSYSTEMS—B.T.U. E.A. ; <br /> LAVATORY(WASIi i HEAT PUMP <br /> SHOWER � UNITHEATERS—B.T . M <br /> KITCHEN SINK 8 DISP i CLOTHES DR i <br /> DISHWASHER � VENT ON FAN <br /> LAUNDRV TRAY NGE HOOD i <br /> CLOTHES WASHER WATERHEATER � <br /> URIVAL ' WOOD STOVE <br /> GRINKING FOUNTAIN I METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � PLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GASF LACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE ' <br /> � GAS PIPING ' <br /> ; EXHAUST FAN � <br /> � ' <br /> i — <br /> SUBTOTA! S � SUBTOTAL S i <br /> PERMIT 5 i PERM!T 5 � <br /> TOTALFEE S � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SFTBACK SIDE SETFIACN PIAN CHE C NUNOER FEE RECEIPT N0. <br /> Fi., <br /> 1�i� <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> i <br /> f7YE5 fi NO BUILDIM1G j <br /> HEIGMTLIMITATION NO.OF�WELLINO SIZEOFOIOG/C1. � <br /> i <br /> UNITS PLUMf31NG � <br /> OCCUPPNCY YO OF5IGRIES OLCUPANTLOAp BASEMENT � <br /> GROUP MECNANICAL i <br /> (1 YES Il NO � <br /> i <br /> FlRE ALARM REO'D REASON AD�I710N�L PLAN CMECH � <br /> i <br /> OtHEH i <br /> FIRESPPINKLERREQ'U REn50N � <br /> STATE B W LCRIG 5l1RCNMGE � <br /> TYPEOFCONST. PLANSAAPROVEOBY CITYOFEVEFE7T P��BLICWORNS i <br /> LOCALSALES — � — <br /> DATE TAX CODE IS 3105 TOTAL � <br />