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� , <br />APPLICATiI.� FOR COPISTRUCI.ON PERNIIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />I-1 DEMO�ITION � I COMBINATION i i gUILDING `' MECHANICAL Il PLUMBING I i SIGN <br />PROJECT ADDRESS y� �� � � � <br />O <br />OWNER MAiLADURE55 C�tt IiP PHOrvE <br />(,"ilibl�-�T% Y�-✓J ,'�7 / ���/�i's. �!/C—'�-r%� `��1u/ a,1- y��5 <br />TENANT �AFIIApDPE55 GTV ZIP PHONE <br />"i-� sta.ds rds«�. a��8 �l�-tA�� ��«�,r- yxZ�� as9-F�y� _ <br />ARCNIT GTOR�ESIG�JER MAILRODRE55 CITY ZiP PHOVE <br />GENERRLGONTRRCTOR MnllAp[ <br />C� �„ i �� tr /� <br />MECIIANICALCONTPACTOR MFLLAO[ <br />CITV 71P <br />� <br />71{� PMONE STATE LICENSE � <br />PLUMBINGCONTRACTOR MAILR�ORE$$ piV ZIP PHONE STATELICENSE• <br />..............,.,,.�.,� . .,��v U, o� <br />DESCPIBE WORK 4ND SOUnRE FOOTAGE INVOLVED <br />NJ i-f-� L <br />USE OF BUILDING <br />LEG4L 7ESCRIPPON OF PROPERTY (SNO\YN BELOW OR iTTPC111 w0 �Or'IES <br />NLOT '�a1 4 z I OLOCK ��"3 OF � O I " E�L <br />— %L�� 02p� O10 3 <br />WNSTRUGT�ONLOANLEN�ER,PDORESS.TELEPNONE NUMBER <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTE <br />SINK (SERVICE — BAR, <br />SUBTOTAL 5 <br />PERMIT 5 <br />TOTALFEE 5 <br />FOR OFFICE USE ONLY: <br />FROM SE7BRCN REAR SF.TOACK SIDE SETBACK <br />US@20NE <br />HEIGHi LIMIiATION <br />NO 0� Si0RIE5 <br />LGiAREA <br />NO OFOWELUNG <br />UNITS <br />OCCUP4NLLOA� <br />fiEA50V <br />VACRNT SITE <br />f1YE5 <br />9ZE OF 9lDG/TI <br />FEE <br />� I NO <br />HEATING SYSTEM: fl GAS f 1 ELECTRIC �l _ <br />cor+Tna so�n rr�oNe N <br />C�' l, �-,� %',� �M., ,��� - s�� <br />I HEREB'! CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION ANO KNOW THE SAME TG BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LA'NS AND ORDINA.":CES GOVERNING THIS TYPE OF <br />WORK WI�L BE COMPLIED WITH WHETHER SF'ECIFIED HERFIN OR <br />NOT. THE GRANTIIJG OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR l.00A� LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED L'Y THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITFI THE STATE <br />CONTRA��TT// DRS LAW 1827i� W AND 296.200 WAC. <br />X ,6 A-�`�b1 ���F�4_— �a � � %t `J <br />SIG ATUHE OATE <br />C'TV DIISMEES LICENS[ NO <br />MECHANICAL _ <br />NO. TVPE OF FI%TURE OR ITEM FEE <br />T <br />A/C —NHNULG UNITS — H.P. � <br />FORCED AIR SYSTEMS — B.T.U. M E.A. � <br />--r— <br />HEAT PUMP � <br />UNIT HEATERS — B.T.U. M <br />CLOI'HES DRVERS <br />� T <br />VENTILATION FAN ' <br />F�.NGE HOOD � <br />WOOD STOVE <br />METALFIREPLACE <br />FIREPLACE INSER'� <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />SUBTOTAL 5 <br />PEHMIT 5 <br />TOTA� FEE S <br />r.nNu�E{rcN3oen7 Ir�e IaEceiarNo. <br />�-liri � <br />ONLOIN(7 <br />PWMBiNG <br />BASEMENt MECIIANICAI <br />nves i: r+o <br />�DDIilONr1L PL1N CHEGK <br />OTIIEH <br />StATE 8 W IDING SIIRCHRBGE <br />CITY OF EVERETT �UBLIC WORKS <br />LO�ALSALES <br />TAX CODE IS 3105 TOTAL <br />