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APPL�CATI�1 FOR CONSTRUC'. .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETi, WA 98201 •259-8810 <br /> ❑ DEMOLITION fl COMBINATION 6d BUILDING ❑ MECHANICAL f7 PLUMBING ❑ SIGN <br /> PROJECT ADDRESS 37�3 ,�a R , o N ,�v�. �����. �.-T qg�,p� <br /> OWNER MAILPDDRESS CITY ZIP PIIONE <br /> m. Do��ac Oav,'s 37p3 Nvr��,n ,�ue Cv��Q-tt y��o► �S�—� 9 �l� . <br /> TENAN�� MAILAOURESS Cltt 21P PHONE <br /> RRCHITECT OR DESIGNER MAILADORE55 CITY ZIP PHONE ' <br /> U W NE�2 <br /> GENERALCONTRACTOR MNLROURESS CITV 21P PHONE STATELICENSE� <br /> MECHANICALCONTRACTOR MAILADDRESS CITV ZIP PIIONE STATELICENSE� <br /> PLUMBINCaCONTRACiOR M0.ILAODRESS Lltt ZIP PHONE STATELICENSE/ <br /> CONTPACT PRICE OF WORN <br /> HEATING SYSTEM: ❑ GAS O ELECTRIC ❑ <br /> DESCRIBE WORN ANO SOUARE FOOTAGE INVOLVED CONTACT PERSON AND PIIONE NO. <br /> f2n e `�/Y' C-�►^cc..� 5 <br /> Cph c ref� F7v�r� - u�o �'am e. <br /> �L�I Q s F�-i 1 HEREBY CERTIFY THAT I HAVE READ AND EXAM�NED THIS <br /> v APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.AlL <br /> PROPOSED USE OF dIIILDING pROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF , <br /> U f�OL S�O WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRIPTIONOFPROPE Tv(sHo BELOWORATTACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior�e�ocK�oF r � Q � AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> n I ��1 � � �� � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> �•i Gt PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> U D I, 3 , �'� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAPCELTAX I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTAl1CT10N LOAN IEN�ER.ADDRE55,TELEPNONE NUMBER x ���(/ � /(�`�t� SuN l 3. l 995` <br /> SIGNATUFE �ATE � <br /> CITY BUSINE55 LICENSE NO. <br /> � PLUMBIN6 MECHANICAL <br /> NO. TYPE OF fl%TURE OR ITEM FEE NO. TYPE OF FlXTURE OR ITEM FEE <br /> • WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. � <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. ' � <br /> � <br /> IAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRYEflS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDfiY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS i GAS FIREPLACE i <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ' GAS PIPING ' <br /> � E%HAUST FAN � <br /> � � <br /> i � <br /> i � <br /> � � <br /> SUB TOTAL 3 ; SUB TOTAL $ � <br /> PERMIT 5 � PERMIT $ � <br /> TOTALFEE S ' TOTALFEE 5 ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSET�AC� PERRSETfiACK � 9�ESETBACK / PLANCHECKNU�jF�� FEE �/�S�\ R//// D <br /> N y��� S� C/ <br /> USEZ(JI�E f I LOTAREA VACANTSITE FEES VALUATION FEE — <br /> V ❑VES ❑ NO <br /> �— euaoiNc <br /> HEIGNTLIMI R�1N VNIT$FOWEWNC SIZEOFBLOGRI. i <br /> � I /fj, �„IQ G PLUMAIAG � <br /> V <br /> OCCUPANCY NO OFSTORIES OCCVPANTLOAO 9ASEMENT MECHANICAL � <br /> GRO I ( <br /> ❑VES 1 O i <br /> FIREAURMREO'D REASON ADDITIONALPIANCHECK i <br /> �O OTHER � <br /> i <br /> FIRE 3PPINKLER REO'0 REASON � <br /> N� STATE OUILOING SUIICHARGF. �� <br /> TVPEOFCONST. PlANSAPPPOVEDBY CITVOFEVERETT PU�IICWORNS •—�� <br /> �I �-�' LOCAL SALES � <br /> Y- i.� DATE Zo �' TAX CODE IS 3105 70TAL � <br />