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APPLICAYIO.� FOR CANSTRUCT�JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION \� <br /> 3200 CEDAR STAEET• EVERETT, WA 98201 •259-8810 <br /> 9C DEMOLITION �(! COMBINATION ij( BUILUING f-7 MECHANICAL �� PLUMBING rl SIGN <br /> PROJECT ADDRESS � <br /> ��-1�� No �� A�iF ��et� l,U '�l �l$a,G 1 <br /> ownEn_ - �1 n+aano1oaess ,r� <br /> 1L�1�1� 'Af7 I ��t� � '� H-�1 c'F�P� nr ri�a�e <br /> ,ENAN, 4 n� Ca�c> �S �lS�o�l <br /> MAIL4pDRE55 CIiY 21P PHONE <br /> —\L'fT m P <br /> lRCHITEGTORDESi tJER MAILA��RE55 GTV TiP PHpNE <br /> n� ia <br /> GENCRALCn JiR CiOR MAILADDRE55 UtY qP pHONE SLC'EIIGENSEx <br /> S�_1 T <br /> MECNANICALCONTR�CTO(i MAILADDRESS CIN ZIP PHONE STATEUGENSE� <br /> r•III <br /> PLUMBINGCONiRACTOR MFILA�DRES CITY 21P PHONE <br /> STATE LIGENSE� <br /> CON�qACt RICEOFWOqK <br /> � 7�U.�.. HEATING SYSTEM: I�(GAS rl ELECTRIC fl <br /> DESCRIBE W RN ANO SO lA E F00 AGE INVOIVED CONTACT PEPSON AND OkE NO. <br /> U T <br /> i I <br /> e. yJ '��� <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PRO OSED lISE F BUIIDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPER7Y�SHOWNBELOLYORATTACHTiYOCOPIE51 WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> 1 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or 7 $.R BLOCK �93 oF�y� 1 AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUC710N.THAT I AM AUTHORIZED BY THE <br /> _ OWNER OF THIS PROPERTY TO PERFURM THE WORK FOR WHICH � <br /> - - - APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> rnace�iax i.o.NUMAea CONTqACTOFS LAW 18.27 RCW D 296200 WAC. <br /> ' , � — ' , � � '� � �� / <br /> GONSTRUCTIONLOANLEN�ER.F�DRESS,TEIEPHONENpMBEq x ��� <br /> SIG AT qE DATE <br /> CITY USINESSLICENSENO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. i <br /> BATHI UB � FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASW) � HEAT PUMP <br /> SHOWER � UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS ' <br /> DISHWASHER VENTILATION FAN � <br /> LAUNDRY TRAY ' RANGE HOOD <br /> CLOTHES WASHER � WATER HEATER , <br /> URINAL WOOD STOVE <br /> DRINKING FOIINTAIN i METAL FIREPLNCE(WOOD BURNING) ' <br /> i <br /> FLOOR DRAIN � FIPEPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PFiEVENTERS � GAS FIREPLACE � <br /> SINK(SERVICEi—BAR,ETC.) i GAS RANGE � <br /> i GAS PIPING <br /> i EXHAUSTFAN � <br /> i <br /> SUB T�TAL 5 ! SUB TOTAL S ' <br /> PERMIT 5 i PERMIT S i <br /> TOTALFEE S � TOTALFEE 5 � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETOACK ?p RGq SFT9ACN SI�E SETBnCK PLAN CIIECK NUMOER F[[ RECEIPTND. <br /> l✓� <br /> � � ,��, �y�-� <br /> usezoNrp �otnnea vncnratsrte FEES VALUATION FEE <br /> (L� � �(�[f3 nvEs �o eunoiruc �'l <br /> HEIGIITLIMIt�TION NO.OFpW[LLING SIZEOFOLDGRI ZpZ iO�/ <br /> p p_ UN175 / I(�� F. rOR4� P�UMpIYG � <br /> (iCJ �J � <br /> CCCUPANGY p0 CPS*C�IES OCCUPANTlOA� pASEldENi � <br /> GBOIIP MECHANIGAL <br /> i <br /> �� I i <br /> LVES NO <br /> FIFE AIARl,1 REO-D qEASON AD�IiIONAL PLAN CHEGN � <br /> OTIIEP, � <br /> i <br /> FIRE SPqINKLEf;REO'� FEASON � <br /> i <br /> STAiE pUILOING SURCII�RGE i�-vl <br /> C/ <br /> TYPEOf CONST �LANS�PPROVeqey CITY OF EVERF.TT PUBIIC WORKS i <br /> �J' m/ � LOCALSALES ' <br /> JL'"1�J nn;��Z/ � (o TAX CODE IS 3105 TOTAL � ;5D <br />