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— ., <br /> APPLICATIt,�I FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> 17 DEMOUTION fl COMBINATION ffi BUILDING s� MECHANICAL pd PLUMBING f-1 SIGN <br /> PpOJECT ADDRESS l/ <br /> ZZ30 223Z 6i'unc� - GUo/a !T <br /> owneA MannooaEss �D Bo�t S�/V �T�'?� zm rnoNE <br /> � �nwe5v�. . �a�e5 � g��?06 b� oyoy <br /> TENaN�—� M.u�nooaFss cm zia rrior+e <br /> ARCHITECTOROESIGNER MAILAUJRE55 CITY ZIP PHONE <br /> GENERALCONTAACiOR MAILAOU�ESS CITY ZIP pNONE STAT�LICENSE. , � _ , � <br /> �JC.� <br /> e Leo , L�u s�en. /�wv s - /70/ oz � vi hu� L,�l f��e� 1.e.�4�a �3 v���:�.ot=ct.c�TA; <br /> MECN�NIGALCONTAACTOR MAILADCAE55 CIiV ZIP PNONE ATELICEN54� <br /> PLUMBINGCONTq�CTOR MAIL�ODRE55 �ITV ZIP PIIONE STATELICENSE� <br /> /�,w � I An� <br /> CONiA�CT pF K <br /> / � HEATING SYSTEM: ❑GAS ❑ ELECTRIC <br /> DESCPoBE WORK AND SOU�RE FOOT�GE INVOLVED I CONTnCT PERSON AN�PNONE NO. <br /> �IF� �rl�� •���3G�l��1 <br /> � <br /> �u E/a ; <br /> I HEREBV CERTIFV THAT 1 HAVE READ ANU EXAMINED THIS <br /> PHOPOSED USE OF BUILDING APPLICAI�ION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> � WORK WILL BE COMPIIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�LOESCRIPTipNpFPRppE ($NOWNBELOWORRTTRCNTWOCOPIES) NOT. THE GRANTING OF A PERMIT DpES NOT PRESUME TO GIVE <br /> iorES_ 17t1� e�ocK �fr3 or ��� t'� AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION Op THE <br /> Q«u7/�fl'� �µ0� R � � I�JI ���� OWNER OFNTHIS P O EFiTV 70 PERfORM THE ORKIF R WHICH <br /> � 3Z � ,�Js e{ � I�. C�p APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> P RCELTA%I.D.NUMB R CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> 3 — �/�'3—O/ � �1���L�-� �i�� �! <br /> CONSiAVCTiON LO�N LEND@R,ADDRE55,TELEPMONE NUMBER <br /> � � ATURE � D�TE <br /> CITv Bu5NE55 UCENSE NO. <br /> PIUMSINO MECHIINICAI <br /> NO. TYPE OF Fl%TURE OR ITEM FEE NO. TYPE OF FlXTURE OR ITEM FEE <br /> WATEH CLOSET(TOILET) � p/C—MiNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> (� LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> �y KITCHEN SINK d 'JISP i CLOTHES DRYERS i <br /> Z DISHWASHER � YENTILATION FAN � <br /> LAUNGRY TRAY ; RANGE HOOD ; <br /> / CLOTHES WASH'cR 3 WATER HEATER � � <br /> URINAL WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE <br /> ' GP.S PIPING ' <br /> � EXHAUSTFAN i <br /> � � <br /> � � <br /> � � <br /> � <br /> SUB TOTAL S � SUB TOTAL $ � <br /> PERMIT $ � PERMIT E � <br /> TOTAL FEE E ' TOTAL FEE 5 � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBRCN PEAR SETBACN SIOE SETBACK PtAN CHECK NUM9ER �EE RECEIPT N0. <br /> C� �' �" ) �/ 2�/ ,� <br /> usezo� .�� �ornRen VACRNT51 E FEES VALUATION FEE <br /> n ves n No ew�oiNc OZ o I r <br /> HEIGHT LIMIT�TION NO OF DWELLI C. SIZE OF BIOGrtI. i <br /> �q' UNITS � �XIS7 ' PWMAMG / CJi <br /> � � I� <br /> OCCUPRNCY NO O�Si0AIE5 OCCUPANTLOAO BpSEMEN7 M[CHANIGRI � <br /> GR UP <br /> 1� - 3 Z N � � ,, No ', <br /> FIRE AURM REO'D RERSON ADD1710Nr1L PLAN CHECK i <br /> d OTHER � <br /> i <br /> FlFESPRINKLERREO'D RERSON � <br /> N O STATE BUILDING SURCHARGE i � <br /> iYPE OF CONST. PUNS APPR ��ev CITY OF EVERETT PUBLIC WORKS � <br /> LOCAL SALES ' <br /> �-1.1 DR1E Z �j TAX CODE IS 3105 TOTAL �� �_ <br />