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APRLICATIQ�1 FOR COldSTRUCTi�N PI:�iMIT <br />CITY OF E'JERETT • BUILDING DIVISION ������� <br />3200 CEOAR STREET • EVERETT, WA 98201 • 259•8810 <br />rl DEMOLITION � COMBINATION �� BUILDING r� MECHANICAL �' PLUMBING f! SIGN <br />PROJECT ADDRESS <br />❑n zm r+Hor,e <br />� Li i�/FJ/ .'_' SiI <br />MECHANICALCOYTRAf.TJP MN�pDUPE55 CITV LF PMOKE STATEUL[NSE� <br />PWMBINGCONTRAf.TOR M0.1LAD�RE55 Clil' ZIP PHONE STFTEUCENSE� <br />PA�CE OF WORK <br />��cr%• ��' <br />YORKAND£OU�FE <br />0 <br />:"li�.�.L'�i�/� C`�ChG�',[iL,�.� .E�G. <br />,C����V�',r/T/.0 f — <br />PAOPOSED USE OF BUI�DING <br />LEGAL DESCRIPTNNOF PqppERTY (SNOYM AEiOW OP RTIAGM : WO COPIES� <br />ior .�_ eiocK � oF /-.�T /r .O✓n � <br />//.�.c,.ci..rP r.!c...�,�,./l._../l�n'( <br />.� <br />F�l,�,t5' f�G . L- / <br />_R � <br />, �/9D �?,�' �.a?� <br />LENpER. AD9. �; ,� i TE' _PHONE NUMBEF <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />/ WATER CLOSET (TOILET) <br />/ BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />/ UISH\NASHER <br />i LAUNDRY TfiAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. El <br />PERMIT 5 <br />TOTAL FEE 5 <br />FOR OFFICE USE nNLY: <br />PRONiSFTAACN PGAR SF.TBACK SIDE SETB�CK <br />USEZONE �lOiAfiER <br />NEIGIII LIA�ITATION I NO OF UWF.LLING <br />UNIfS <br />OCCIIPANCV NOOPS�ORiB OCCUPANIIOAD <br />fIRF $f'RiNNI ER <br />unrE <br />HEATING SYSTEM: f� GAS ` i ELECTRIC f l <br />CONiACT PFRSON AND PHONF. NO . <br />I HEREBV CERTIFY THAT I HA4E READ AND EXAMINEO THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC7 ALL <br />PROVISIONS OF LAWS AtJD ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED F'.EFiEIN OR <br />NOT. THE GiiANTING 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 CONS7RUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER O� THIS PROPERTY TO PERFORM TF!E WORK FOR WHICH <br />APPLICATIO IS MADE QND I COMPLY WITH THE STATE <br />CONTPA Ob5 iAW 1�CW AND 296200 WAC. <br />x / �-1 _� <br />SIGNA URE - pqTE ' <br />CITY BUJYE55 LIC[1iSC NO <br />MECHANICAI <br />NO. TVPE OF EOUIPMENT FEE <br />A/C—A/HNDIGUNITS—H.K —T <br />FORCEO AIR SYSTEMS — B.T.U. Ivt E.A. ; <br />HEAT PUMP � <br />UNIT HEATERS — B.T.0 M � <br />CLOTHES DRYERS � <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATEH <br />WOODSTOVE <br />METAL FIR3PLACL (IVUUD bURNING) � <br />FIREPLACE INSEhT IWOOO BURNING) <br />GAS FlREPLACE � <br />GASRANGE <br />GAS PIPING <br />/ ExHAU5TFAN ' <br />SUB TOTAL S <br />PERMIT 5 <br />TOTALFEE 5 <br />�I4NCIIEC�(NUt�IffR � f[f � RFCHPTNO <br />vncnr�r srte � FEES <br />r ivEs r�� r;o oi�i��i��r <br />9ZE 0� PtUGrt I <br />�Xf�� � f'LIIMpi�1C <br />BASF.MENi� RIpCp�NICAL <br />14F5 I I NO <br />ADpI I IOVAL F14N C��f_CK <br />on+en <br />tiiN[ UIIIl01NG SUIICNMGE <br />CITY OF EVERETT ^unurwonKs <br />LOCALSALES <br />� TAX CODE IS 3105 TOTAL <br />2 'OJ <br />1 <br />�i i�l <br />) �� �; .. <br />✓ � W <br />—�.. — �����/ , /J <br />�__._ <br />