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�APPLIGATIOr� F1DR CONSTRIJCT�JN PERM17 <br /> CITY OF EVER�i T• BUILDING DIVISION � <br /> 3200 CEDAR STREE� • EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOUTION ❑ COMBINATION rl BUILpING Cl MECHANICAL C PLUh1BING fl SIGN <br /> PROJECT ADDRESS,� � �� �/����� <br /> % r� <br /> O /E�A � MAILADDRESS �� CITY .ZI/ 'j. ' PNONE n. <br /> l�If1 /� / ) n J I j � �) / / <br /> r/�'( (ry/ V • ^V1V, l��✓� -� .Y /.��.�'./._,/�.-� I� !� . !"• _ //(�\l <br /> tEN T MAILAOORESS �C� 21P PHON[l <br /> pRGMRECTOR0E51GNER MAILA��RE55 CIiY IIP PHONE <br /> GENEfiALCONTRaCiOR MFILAODRLSS � � �J �/ <br /> CITY ZIP PHONE STATE IICENSE� <br /> C�1� IC��71f]iLG�n IIIA�: �AJ��.� VlC.1�.L'� _ <br /> m � N R� � � Z�p 7110NE STAiE LICENSE� <br /> MECNANICALCO ACTOR MAILpD�RESS ��T� <br /> —���U �i,� ' .Z?�.-�5 -��'�r�i�l�. ti.u.�_�h�v,,,�c� SYv�iz 10�� 4��4� TW�nlCP�c�m�� <br /> VIUMBINu CONTRACIOR MAl1 A�Df: CITV 21P PHONE SiATE IICENSE� <br /> cor+rnncrrniceoFwor+K HEATING SYSTEM: �GAS ❑ ELECTRIC f_7 <br /> DESCRIBE ORK A1 p SOUAPE FOOTAGE MVOLVED C NTACT PERSON AND PPON I O. <br /> v � <br /> 3� — ' 3z <br /> I HEREBY CERIIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TAUE AND CORRECT.ALL <br /> PFOPOSED USE OF BUILDIIlG PROVISIONS OF LP.WS AND ORDINANCES GOVERNINC �-HIS TYPE OF <br /> WORK WILL BE COMPL�ED WITH WHETHEF SPECIFlcD HEREIN OF <br /> IEUALDESCFIPTIONOFPROPERTVISMONM6@�OWORATfACHTWO(APIE51 NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br /> �or_ e�ceK_ oF_ AUTHORITY TO VIOLHTE OR CANCEI THE PROVISION OF ANY <br /> OTHFR STATE OR LOCAL LAW REGULATING CONSTAUCTION OR THE <br /> PERFORMAPiCE OF CONSTRUCTION.THAT I AM AUTHORIZED �Y THE <br /> OWNFR OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MHDE AND I COMPLY 6YITH THE STATE <br /> CpNTRACTORS LAW 1827 RCW AND 2962.10 WAC. <br /> PqRCELTA%I.D.NVMBER /� <br /> �� � Iv�l�,/5 �F <br /> CJNSTFlUCTION LONN LEN�ER,ADORESS,iELEPHONE NUMBEA x � � � �-'�� / ,� 't� <br /> SIGN U�E DATL <br /> (l)Z��%S'� <br /> CITV BUS�NESS UCENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> \YATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> I.AVATORY!WASH BASIN) i HEAT PUMP _ ' <br /> SHOWER � UNITHEATERS—B.T.U. M � � <br /> KITCHEN SINK&DISP I CLOTHES DRYERS . ' <br /> DISHWASHER VENTILATION FAN � <br /> LAUn�RY TRAY ' HANGE HOOD � <br /> CL6THES WASHER � WATER HEFTER ' <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GASFIREPLACE _T— <br /> SINK(SERVICE—BAR,ETC.) i GAS RANGE <br /> GAS PIPING � <br /> � EXHAUSTFAN ' <br /> � ---'r_ <br /> i <br /> � <br /> � SUB TOTAL S _3' 1i <br /> — SUE'�TOTAL 5 � pERMIT S <br /> � <br /> PERMIT S JD � � <br /> TOTALFEE S (O.�- ' TOTAIFEE S <br /> FJR OFFICE USE ONCY: — aeeemrNo. <br /> PLAN CHECN NUMDER 1 2 FEE <br /> FRONTSE1E3nCK R'-4RSETBAGK SI�ESET9RCH ���. <br /> FEES VALUATION FE_�_ <br /> VSEZONE IOTAREA VACANTSICE i <br /> IlYES fl NO i <br /> Ol11LDING - <br /> HEIGHTLIMITPTION NO.OFDWEWNG SIZEOFBLDG�11. � <br /> i <br /> UhiTS PLUMPING "'L��-- <br /> i <br /> i�� � <br /> OCGIIPANC� NJ OF 5T09iF5 OCCUPANT LOAD BASFMENT MECHAMCAL � <br /> i <br /> GROUP ❑YES Il NO � <br /> AD�IIIONRLPLANCNECN � _ <br /> FIREALARMREO'D REASON � <br /> OTN_R � - <br /> i <br /> fIRESPRINNLERREO'D PEASON <br /> STATE OUIL�ING SURCNARGE � <br /> _ � <br /> TYPE OF CONSi �'�NSAPFROVEO BV CITY OF EVERETT PU911C WORRS � _ <br /> LOCAL SALES � � ; �)) <br /> TAX CODE IS 3105 70TAL I <br /> DATE <br />