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APPLICATI�•�1 FOR CONSTRUC1�aN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAFi STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION O COMBINATION ❑ BUILDINfi ❑ MECHANICAL ❑ PLUMBINO ❑ SNiN <br />ADDRESS <br />OMMEF MIULADORE55 CITY Z�P r'^�^� <br />Marlene Withere P.O. Box 3188 Arlingtm, WA 98223 �35-5037 <br />�� MAIIADDRE55 CITY ZIP P�E <br />ARCHITECTORUE516NER MALAOORE55 CIY ZIP PHONE <br />pENEMLCpN1RACTOR MAILAWRE55 CITY 21P PHONE STIITELICENSE� <br />Marlene Withere P.O. Box 3�88 Ar1lnBton, WA 98223 435-5037 <br />MECNMlICI1LCONiRACTOH MNL�DdiE55 CITY ZIP PHONE Si�TEUCEN5E1 <br />p��hIOMpCpNTpACTpN M/�IL�DONESS CITV 21P PNONE ST�iEUCENSE� <br />Robineoa Plumbing, INc. 607 sE Ev Mall WaY k26� �erett, WA 98208 355-6171 RUBINP*272C2 <br />pE5�p�9E WqIK �ND SOUARE FOOTI.6E INVOLVEO <br />ior �� <br />� VNICELTl1%I.D.lK1MBER <br />' . rtviSmuC710N IOAN LENOER <br />TELEPIMNE NUMBEN <br />TYPE OF Fl%TURE <br />WATER CLOSET(TOILEn <br />BATHTUB <br />LAVATORY(WASM BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />FOR OFFICE USE ONLY: <br />F{qNT$ETgACK REM! <br />SUB TOTAL S <br />PERMIT S � <br />TOTALFEE S ' <br />SIOE SETB�CK <br />VACANT SITE <br />❑YES fl NO <br />NEIGMT LIMIT�TION I �ITSF DN'EwNO <br />ND. <br />SIZE OF BLD6RI. <br />❑VES f7 NO <br />HEATING SYSTEM: Cl (iAS ❑ ELECTRIC ❑ <br />CONiACT VERSON �NO PHONE NO. <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED TH13 <br />APPLICATION AND KNOW T HE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES OOVERNINQ ?HIS TYPE OF <br />WORK WILL BE COMPL�EC WITH WHETHER BPEC�flED HEREIN OR <br />NOT. THE aRANTINQ OF A PERMIT DOES NOT PRESUME TO aIVE <br />AUTHORITY TO VIOUTE OF CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL UW REOULATINO CONSTRUCTION OFl THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV TME <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FqR WH�CM <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 182� RCW AND 296200 WAC. <br />X ���r�— i/��a� <br />SIQNATUNE DATE <br />CI7Y BUS�NESS UCENSE NO. <br />MECHANICAL <br />A/C — AIHNDLQ UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTIUTION FAN <br />RAN6EHOOD <br />OAS PIPIN <br />EXHAUST <br />SUB TOTAL 5 <br />PERMIT S <br />TOTAL FEE S <br />__ FEE� �j RECEIPTNO. <br />��.. <br />2/ <br />BUILDING <br />PLUM9ING <br />MECNANICAI <br />ADD�710N�L PUN CHECN <br />OTHEP CR_ jnlrl cr 1 <br />STAiE ' JILDING 4URCNARGE <br />CITY OF EVERETT PUBLIC WORKS <br />IOCALSALES <br />TAX CODE IS 3105 TOTAL <br />