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APPLICATION FOR CONSTRUCT�ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDNR STREET • EVERETT, WA 98201 • 259-BB10 <br />rl DEMOLITION G7 COMBINATION f�BUILDING fG�MECHANICAL �LUMBING fl SIGN <br />PROJECT ADDRESS ��� p ( 7 -h �/ <br />OWNER MnILADDRE55 CITY ZIP PHONE <br />,E�.� � "`_'� MA, 7�� 5S -3F �! �,..0 4! � �TY 5.��,�..1 w� 9b:�o .� - �5:� - /3 a 9 <br />�RCNITECTORDESIGNER MRIIADDRE55 CITY 21P PHONF <br />GENEMLLONfPny� ORn MM�PDORESS C11Y ZIP PIIONE STATELICENSE� <br />:1�a.�i'!.4 �r�.�cp� S�r,r� �'� 2�-•�•-�- /c�A /,��3 Sc o S5— ff 1 <br />r.m zm <br />PLUMBING CON7R�CTOH MRIL A�DRE55 CIIY 21P PMONE STATE LICENSE � <br />PRICE GF WORK <br />DESCRIBE WORK �ND <br />PROPOSED USE OF BUILDING <br />� <br />iot �,% e�ocK <br />� <br />COHSTRUC7�ONlOANLENDEfl.�00RESS.TELEPMONENVMBER <br />NO. TYPE OF FlXTURE OR ITEM <br />2 WATER CLOSET (TOILET) <br />1 BATHTUB <br />SHOWER <br />KITCHE�: SINK 6 DISP <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SINK (SERVICE — <br />SUB TOTAL S <br />PERMIT 5 <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />PRONT SFTPA�N .� REAfI SF.TB�CK <br />USE ZONE <br />� � <br />HEIGMTUMITA N' <br />OCCUPANCY NO 0� Sf0aiE5 <br />f,ROUP ' <br />, y. <br />FIqE I1URN REO�D <br />iIRF. SPRINNt ER RF.O'� <br />l0T <br />NO OF OWEILING <br />UNIIS <br />ri <br />OaIE <br />HEATING SYSTEM: !L1'GAS fl ELECTRIC fl <br />GONTRCT PFR$QN AND Pj10N� NO A /f <br />I HEREBY CERTIFY TViAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNC�'N THF SA1AE TO 8E TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS ANr, ORDINANCES GOVERNING THIS 7YPE OF <br />WORK WILL BE COMPL�ED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES N�T PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL Th� eiOVI510N OF ANY <br />OTHER STATE OR LOCAL lAW REGULATING . �� RUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM HU I HORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTiiACTORS LAW 18.27 RCW AND 296200 WAC. <br />X.�' �r �u� �- al- 96 <br />SIGNATURt 04TE <br />CITY BUSINESS LICENSE NO. <br />NO. <br />ac — wnnuw unn a— n.r. <br />FORCEO AIR SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />UNITHEATERS—O.T.U. M <br />RANGE HOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE i <br />FIREPLACE INSERT <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SIOE SETB�� / I PIAN LIIECK NU40fR <br />..._,c n.9 � <br />VAWNi $ITF. <br />f IYES f 1 h0 OUIIDMG <br />�( S.P. �-IVIG/t� PLUMOING <br />3 S.G GA�Ao� <br />BASEMENT �� MEGIANICnI <br />IIVES IVAO <br />Af10p10NM PLpN CIIf.GK <br />OIIIER <br />STNE OIIIlO�NG SUfiClUfiGE <br />CITY OF EVERETT runnr.vrones <br />LOCAL SALES <br />TAX CODE �S 3105 iOTAL <br />� <br />T <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTALFEE S <br />FEP / RFCEIPiNO. <br />3C� � <br />VALUATION FEE <br />S�i �3z - `� <br />�'"1- <br />�� (l <br />