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� <br />APPLICATI�,N FOR CONSTRUC'� .ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />f� DEMOLITION fl COMBINATION BUILDING rl MECHANICAL Il PLUMBING fl SIGN <br />PROJECT ADDRESS /� �� <br />1 ��0 �� �� fi'v�. i Fi�'�/��'� <br />P�ER MNLAOD�ESS Cltt <br />aba�b � 'w�s �o(o rJ;lco Arc r,►,.-.,.�. <br />1/J � <br />i 4zo <br />21P <br />ARCHIIECTORDESIGNER MNLpDORE55 �Iry ZIP PHONE <br />ADORE55 <br />L�3 S <br />LICENSE � <br />� � -�� rn�nt SiqTELIGENSE/ <br />PLUMBINGCONTRACiOR MAIL�DDRE55 �ITY ZIP PHONE STATELICFNSE� <br />OF WOfiK <br />AND SOUARE FOOT�GE <br />i <br />�or �_ BLOCK �� or�s'�' <br />QAn.k- �.(rt- �-n EJtrG�% <br />PRRCELTA%I.D.NUMBER <br />s6�9 -ooV-�o�9 -0003 <br />CONSTq � i1pN LOAN LENOER. ADDRE55. TELEPHONE NOMBER <br />!v K <br />PLUMBING <br />N�• TVPE OF FI%TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BAS�N) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTA�N <br />FLOOR DRAIN <br />SUB TOTAL 5 <br />PERMIT S <br />— I TOTAL FEE 5 � <br />FOR OFFICE USE ONLY: <br />FRONT SETOACK ! REAR SEIDACK , SI�E SEiBrACN / <br />J <br />USEZONE LOTA(iER VACANTSIiE <br />�� I IIYES fl NO <br />HEIGIITLIMJIT'ATIO�I f NOOFDWELLING SIZEOPOLDGRI. <br />/ UNITS <br />UP/NCY NOOFSi0RIE5 OCCUPA <br />�' I <br />.QARMREO'0 fiE�SON <br />SPRINKLER REO'0 FEAFON <br />:OF CON57 PIANS PI <br />��•"' OAT[ � <br />❑VES NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONT�CiP[RSON�NUPHONENO. <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICAI ION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEPNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO �IVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION ^" ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION JR THE <br />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 />CONTRAC ORS LAW 18.27 W AND 296200 WAC. <br />X z�� � a�,A,A� 7-� 9-,� <br />SIGNA UPE DATE <br />LITv OU9NE55 LICENSE NO. <br />NO. TYPE OF FIICTURE OR ITEM FEE <br />A/C — A/HNDLG UNITS — H. P. <br />FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VEN7ILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE <br />FIREPLACEINSERI <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />PL/N <br />ounoir+c <br />PLUMOING <br />MECII�NICAL <br />AUDI90NAL PLAN CIIECK <br />OiHER <br />STATE BUILOINC SURCHr1RGE <br />PUDIIC WOtiKS <br />TOTAL <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE S <br />FEE REf.EIPTNO. <br />�G-. os <br />� �� <br />/� <br />� <br />J <br />