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�IAPLICATIOrd FOR CONSTRUCTrJN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOLITION fl COMBINATION I-1 BUILDING MECHANICAL �l PLUMBING fl SIGN <br /> PROJECT ADDRESS <br /> 3 �' A � <br /> ER M�IL�DDRE55 Lltt IIP PIIONE <br /> �;� ���z.�,_ i 3�a G,�A�.� A� _F��.�� 5��� i <br /> TENANT MAILADOHE55 GTY 21P PNCNE <br /> ARpH1TF.CTORDE5IGNER M�II�DORE55 Cltt ZIP PHONF <br /> GENER�L GONTiUC70F M�IL pDDPESS CIfV ZIP P110N[ SIATE IICENSE� <br /> MECHANICrLC NTR4CTOP M�IIADDRE55 GTV ZIP PIIONE 5T4T IICE SE� <br /> A �;a/�,. .[�,r;-�'.,s /5�i� s�� �T a4,A¢Ho�o AaI'�,�� 93�3 ,�sS-iss/ ��,a��,��ss-aL <br /> PIUMBINGCOMRAf.TOR MAILADORESS / CIIY � 21P PNpNE STATELICENSE• <br /> CONTqAGTPqICEOFWORN � ��`� <br /> HEATING SYSTEM: A�GAS �l ELECTRIC �I <br /> OESCRIBE WONK AND SrOU RE FOpT11GE INVOLVEO CONT�CT PERSON AND PMONE NO <br /> COn✓eKT L�t"� � S �/.t <br /> � . <br /> I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> FiqPOSED USE OF 9UILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> 5 ''�� , PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAlDESCRIPTIONOFPROPERTY�510WNBELOWORATT�CHTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �OT BLOGK oF AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OH LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> _. PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> 7WNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> l.PPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> PMCELTN(I.D.NUMBER CONTRACTO LAW 1827 96200 WAC. <br /> CONSTPlICT10N IOAN LEN�ER.�DDRESS,TEIEPHONE NUMBER X� '���'��iS'Cn� (D`��/ S <br /> SIGN'IURE DRTE <br /> CITV BUSINE55 LICENSE NO. 3�O <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF flI(TURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATERCLOSET(TOILEn � A/C—qMNDLCaUNI7S—H.P. � <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; ar= CLOTHES ORYERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNGRY TRAV ; RANGE HOOD ' <br /> CLOTNES WASHER WATER HEATER � <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) ; <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PHEVENTERS ; GAS FIREPLACE ' <br /> � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ' GAS PIPING � <br /> � EXHAUSTFAN , <br /> � � <br /> SUB TOTAL $ ; SUB TOTAI $ ! <br /> PERMIT S , PERMIT 5 / � <br /> TOTALFEE S � TOTALFEE $ Q � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETp�LK PFAq$FTBRCK SIDE SETBACN PUN CIIECN NUM F P[G REf.fIPi NO. <br /> usEzoNe iotnnen V�CANTSIiF FEES VALUATION FEE <br /> fIY[S I1NO AURDING <br /> NEIGMTLIMITATION NOOFDWELLING 51�OFBlIXiRI � <br /> UNI I$ <br /> 1'1pM01NG <br /> T <br /> O.:GUPANCY Np pi SIOmES OCCUPANT 1040 BASEMF.NT MECIInNILAI i <br /> [ROUP <br /> I IYES Il NO - <br /> ppDI110Nr1L PLAN CN[CN � <br /> FIREAURMREOD RF�SON � <br /> -�- <br /> OtHER � <br /> FIRE$PRINKLER REO'lt PF�SON <br /> STr11E 9111tDMG SUIiL1��RGE <br /> tvre or r.oNsr ri nNs nranoven nr CITY OF EVERETT runur,vro�Ks <br /> LOCAISALES — -- -- <br /> „p,E TAX CODE IS 3105 To7A� <br />