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APPLICATIt.N FOR CONSTRUCI �ON PERM17' <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl UEMOLITION fl COMBINATION 53 BUILDING f-1 MECHANICAL t� PLUMBING fl SIGN <br /> PROJECTADDRESS I�� I ��r�l � � <br /> OWNER MAILADDRESS CITY ZIP PMONE <br /> IF� � 1=Nf�t-n.n\ �aFS L�n�irr--a cC.�k� I`� re IrY�11 I .J �=1Y-inU\" l✓Q �t�[� <br /> TEN�NT �II.ADORE55 C�TY ZIP PIION�- <br /> �� �s_ ��..�,� ��S �x�9� — <br /> ARCHRECTOROESIGNER MAl1ADURE55 CITY ZIP PHONF. <br /> c�/`1G 1-17 FIwV� <br /> G'EN1ERRLCONTMCTd7I I M�ILA�pRE'55 CIiY IIP PIIONE S7r1TELICF.NSE� <br /> W D13�Gn1 "h�}�Q'�jA(Cx �JI I�I�'� S��L�r � Y tN� Il� . GL�R �5-77 /�Al N7IZI�EI-J'��LE�7U� U_ <br /> MELHANICALCONTRRCT R � MAII�ODRE55 CITY ZIP N��a <br /> eo j��is;,,r.irr 94Z5 �2,±'S'� }�M= 1��.�.. ;:x� R�,Z2'� ��-f2p� �arzP-�lo1Zt _ <br /> MUMBINGCONTRIIQOR MAllAODRESS Cltt 21P PHONE STAiELILENSE� <br /> CONTiUC PRICE OF VIORK <br /> HEATING SYSTEM: r!GAS rl ELECTRIC fl_ <br /> �_' QESCRIBE WORN�ND SOURRE FOOTAGE IN7VOLVED CONTACT PERSON AND PNONE NO� 1 . I� � Y� <br /> r _ L �:i. �1� �- �v V <br /> � `/� / � � /�. I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> �1� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC7.ALL <br /> PROPOSEDUSE OF BUILDINQ PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> "� � '� WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HERE��J O't <br /> LEWLDESCRIPTIONOFPAOPERTYI� �BELOWORIITTACHTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> wr eiocK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � _. ,. � - L � � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOFIZED BY THE <br /> ---��� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> S P �Z�2� ,��j Z APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCEL TA%I.D.MIMBER <br /> CONTe7ACTORS LAW 782 7 AND 296200 WAC. <br /> CONSTRUC710N�OAN LENDER,AWRESS.TEIEPHONE NIIMBER - � '� <br /> LYh�ll IO�I I���QRTEIA(� j� - 56c6 GNAiUR �ATE <br /> _ � � C b CITY BUSINE55 UCENSE NO. <br /> P�V��� ' • MECHANICAL <br /> Np, TVPE OF FlXTURE OR ITEM FEE NO. TYPE OF EGUIPMENT FEE <br /> u WATERCLOSET(TOILEn � A/C—A/riNDLGUNfTS—H.P. ' <br /> Z BATHTUB � FORCEDAIRSYSTEMS—B.T.U. M E.A. _ ' <br /> T <br /> LAVATORY(WASH BASIN) � HEAT PUMP ' <br /> SHOWER ' —" UNIT HEATERS—B.T.U. M ' <br /> � <br /> KITCHEN SINK 6 DISP � CLOTHES ORYERS � <br /> DISHWASHER � VEN"IlATION fAN ' <br /> � <br /> UUNDRY TRAV � RANGE HOOD � <br /> CIOTHES WASHER � WATER HEATER S ' <br /> URINAL ' WOOD STOVE � <br /> DRINKIN6 FOUNTAIN i METAL FIFEPLACE(WOOD BUFNING) i <br /> FLOOR DRAIN � -� FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; — GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � — GAS RANGE ' <br /> GAS PIPING � <br /> � EXHAUST FAN r ' <br /> i ' <br /> SUB TOTAL E ' SUB TOTAL S ; <br /> � <br /> PERMIT 3 i PERMIT $ � <br /> � TOTAIFEE S ' TOTALFEE $ ' <br /> FOR OFFICE USE ONIY: �R�I G II�� <br /> FRONT SETPACK � AEAq$ETB�LN SIDE SETPRCK �'UN CIIECK NUMBFf1 FEG� / �� RECF.IPT NO. <br /> 2U 'a l O � /J� /�� t (� 7�/'� � <br /> USEZONE LOT�REA VAC�NfSITE FEES VALUATION FEE <br /> �� � 7 OOU i.Nes �i No ewiort+c O5 Z � <br /> NEIGHT LIMITRION NO OF DWELUNG SItE OF 61004i ��� <br /> i ur+irs � -��{ SF C.n/�iv4 + rwMowc <br /> � � S GaRAc.� , <br /> OCGUP�NCV NOOPSIO�iCS OCGUPANTIOAD BASEMENT MfCMnNICRL � <br /> � � i <br /> GROUP � a f1YE5 MT1� i . <br /> ' ' Ap01710NA1 PL4N CHf.CK <br /> FIRE�LARM REO'D RF.ASON T <br /> i <br /> Oi11ER i <br /> FIRFS�'R�NKLERREO'0 PEASON � <br /> 1�� <br /> STAIE OIIIl01NC SURLIIARfiE � <br /> rvPeoFr,or+sr Pl�NSPPPJvEqav CITYOFEVERETT �UffI1CWORNS � — <br /> �� LOCAL SALES <br /> ��/J onTE 10/3� �!S' TAX CODE IS 3105 TOTAL � d ' — <br />