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. . <br /> APPLICATIO�1 FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBIN(i f_l SI(iN <br /> PROJECT ADDRESS <br /> OMMER M/ULADOi1E5S CITY 21P PNONE <br /> MAYC3Eu EvANs 261� �. (�Re�a F�ie�rr 9gao� 159- YST6 <br /> TENANT MML�WORESS CITV ZIP PHONE <br /> �RCNITECTORDESIGNER MAILADORE55 CITY 21P PNONE <br /> �NrP <br /> �ENEqALCONTR�CTOR MAILADIX7E55 CITV iIP PNpNE STATELICENSE� <br /> N^�dH4� (.�r'ST. L� 3L H�FHv�r.�o .9�F ���tY �-S�-�Y.Sa NAc6RC �Y Z3o�h <br /> MC.:MANICACON7AACTOR MNLADDRE55 CITY ZIP PHONE STATELICENSE• <br /> ttUMlMlOCONTR�CTOR MNLADIXIESS Cltt ZIP PHONE STATEUCENSEI <br /> CONfMCT PPICE OF WORK <br /> S S 8 7 ' HEATING SYSTEM: ❑GAS ❑ELECTRIC f9 �/� <br /> DESCNBE YYORK AND SOU�RE FOOTAGE INVOWED CONTACT PERSON ANO PNONE NO. <br /> c .ao �o s fi✓j rec� 1 -9 <br /> H irc t � c c' <br /> I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> . vnoroseo u9e oF auadrro APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES CiOVERNIN(�THIS TVPE OF <br /> �� � WORK WILI BE COMPLIED WITH WHETHER SPECIflED MEREIN OR <br /> LC-0I1lDE5CPoPfION OF PiIOPERTV(SHOWN BELOW M ATiACH TWO COPIES) NOT. THE ORANTINp OF A PERMIT DOES NOT PRESUME TO OIVE <br /> ioT e�oac oF AUTHORITY TO VIOLATE OR CANCEI THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL lAW REdUUTINO CONSTRUCTION OR THE <br /> S f f A f�(��Cs,&n PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCEITNf I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 298200 WAC. <br /> CONSIRUCTION LW1N LENDEq,�ODAESS,TELEPMONE NUMBER �//�� <br /> �' SIGNAL�—T;��C�Gi'i. O�TE .tG" /S <br /> _ CITY BUSINESS LICENSE NO. b 3 <br /> PCUMSINO MECHANICAL <br /> NO. TYPE OF FlXiURE OR ITEM FEE NO. TVPi OF FlI(TURE OR ITEM FEE <br /> � WATER CIOSET(TOILEn � AIC—AMNDI.O UNITS—H.P. � <br /> BATHTUB ; FORCEDAIRS�STEMS—B.T.U. M E.A. ' <br /> �. LAVATORY(WASH BASIN) � HEAT PUMP � <br /> ' SHOWER � UNIT HEATERS--B.tU. M � <br /> • KITCHEN SINK 6 DISP � CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> ' UUNDRV TRAY ; RANGE HOOD ; <br /> � CLOTHES WASHER � WATER HEATER � <br /> . URINAL ' WOOD STOVE ' <br /> ' DRINKINQ FOUNTAIN i METAL FIREPLACE(\YOOD BURNINO) i <br /> . FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNIN(i) � <br /> BACKROW PREVENTERS i OAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � �AS RANOE � <br /> ' OAS PIPING ' <br /> � E%HAUST FAN � <br /> � � <br /> � — i <br /> ' ' i <br /> � , <br /> SUB TOTAL S ; SUB TOTAL S ' ,, <br /> PERMIT $ � PERMIT S � <br /> TOTALFEE S ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FAONf SETB�CK REAp SETdACK SIDE SETB�CK PUN CMEC UMBER FEE RECEIPT NO. <br /> ��(J�� <br /> usEzode IOTAREA VAC�NTSITE FEES YALUATON FEE <br /> ❑VES ❑ NO BUILDING �[J �v eJJ <br /> HEIOHTUMItATON NO.OFOWEWN6 SIZEOFBLDl3/fl. i <br /> UNITS PLUMBINO i <br /> �UPPANCV Iq,OFSTOPIES OCCUPANTLO�D B/SEMENT MECHANICAL �(� <br /> [JYES ❑ NO � <br /> FlREAURMREO'D REASOV ADOIT70NALPLANCHECN i <br /> OTHER ` <br /> FIRESPRINKLERREO'D RERSOV - <br /> STATE BUILDIN6 SURCM�RGE `� <br /> TIPE OF CONST PlANS APPRO\EG^\ CITY OF EVERETT PUBLIC WORKS � � <br /> LOCALSALES � <br /> OATF. TAX CODE IS 3105 TOTAL '3 ' S <br />