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APPLICATI( i FOR CONSTRUC� _.�N PERMIT <br /> CITY OF EVEHETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION fl COMBINATION �i BUILDING (� MECHANICAL f� PLUMBING f-1 SIGN <br /> PROJECT ADDRESS �, �+�'� <br /> � � <br /> OWNER MAILqDDfiESS CITY ZIP PMONE (.�S 7 <br /> ��? �L�i,U 3� 1 NE�,v�t-7 ��/E; EJi�LLr1' WA �&"Lcl �:�ZS�;•- L$') � <br /> TENFNT MAILADURE55 CITY iIP PHONE <br />' ,u» ;-3t,ACKS <br /> ARCHIiECTOR0E51GNER MRILADDRE55 CIiY ZIP PHONE <br /> GENERALCONiRACT08 MAI�qDUPE55 CITV ZIP PNONE SiATELICENSE� <br /> ��.;N + �'cU,v�� Q�„-'T�ytr�(�1� b�DGS� i65Zi (-�w�9`� L�1NN�ruD �1$os7 �6c� '�4-95SZ <br /> MECH�NICAI CONTR�CTOR MnIL ADDRE55 CITV ZIp pHONE STATE yICEN$E� <br /> 12�wNLP"r�47�L",T <br /> PWMBINGCONTRACTOR MAILA��RESS Cltt ZIP PIIONE STATELICENSE� <br />, CONTRACT PPoCE OF WOy�( A �� // �� <br /> -�i �j HEATING SY M: ❑ GAS ❑ ELECTRIC ❑ <br /> DESCRIBE WORK RNO SOUARE FOOTAGE INVOIVED CONTAC ERSON AN PIIONE N0. p�7w <br /> � I S' '- �OD O F^r ' S.i�.Z <br /> 3���.20 � C, 47 00 �QL� �ll�lnl <br /> �» In L 1� 1 a L�X I S 17 G I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> vaoaoseo use oF euaoiNc � �PPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br />�� S�(�,�G� � � � /� � / p�� PROVISIONS OF LAWS AND GRDINANCES GOVERNING THIS TYPE OF <br /> �� lh'ORK WILL BE COMPLtED WITH WHETHER SPECIFIED HEREIN OR <br />� LEGR�DESGRIPTIONOFPROFEf.N�SHOWNBElO ORATTRCMTWOCOPIE5) <br /> NOT. THE GRANTING OF A PERMIT DOES N�'T PRESUME TO GIVE <br />�. �oT Z iZ L3�BLOCK 5� oF S:v✓� t- W �S AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />�' Z �L OTHER STATE OR LOCAL LALV FlEGULATING CONSTRUCTION OR THE <br /> SFc-Od� AD OnJ - (it/ �� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> I OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> P�'f' /P Lp(L/� l/pL 3 . /�L s' " APPUCATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEI TPX I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> 593G�- 655 - ozl- occ�- <br /> � /' <br /> CONSTAUCTION LOl�H LENUER,ADDRE55,TELEPNONE NUMBER X � � � 7 S <br /> -� ' aN RE D�TE <br /> CI OUSWESS LICENSE NO. <br /> PLUMBING CFIANICAL <br /> N . TVPE OF FIXTURE OR fEM FEE NO. TYPE OF F�XTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> HTUB ; FORCE AIRSYSTEMS—B.T.U. M E. ; <br /> LAVA RY(WASH BA ) i HEATP MP � <br /> SHOWE � UNITHEA ERS—B.T.U. M � <br /> KITCHEN K&D P i CLOTHES YERS i <br /> DISHWASHE � VENTILATION AN � <br /> LAUNDRY TRAY ; RANGE HOOD ; <br /> CLOTHES WA HE � WATER HEATER � <br /> URINAL � WOOD STOVE ' <br /> DRINKING UNTAIN � METALFIREPLACE 000 RNING) i <br /> FLOOR D AIN � FIREPLACE INSE �(W000 B ING) � <br /> BACKFL PREVENTERS � GASFIREPLAC i <br /> SINK(S RVICE—BAR,ETC.) � GAS RANGE � <br /> GAS PIPING/ ' <br /> � EXHAUSTF N � <br /> — / i � <br /> i � <br /> � � <br /> � � <br /> SUB TOTAL S � SUB TOTAL S � <br /> PERMIT S � PERMIT 5 � <br /> TOTAL FEE S � TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBAC� r RE�R SE�C� 51�G SETOv�. PLAN CNECN NUMG R FEE / HECEIPT NO. <br /> !/ C l �! <br /> usezor+e totaaea VAC�NTSITE FEE VALUATION FEE <br /> _ �'- � nves No aw�ou+c (�� C'�- O D /a 7 �SJ <br /> HEIGNTLIMIIATION NO.OFLIWELLING SIIEOFBLDG/fl. i <br /> / UNIT$ PWMBING � <br /> �00 <br /> OCCUPANCV NO.Of9TORIES OCCUPANTLOhO BASEMENT i <br /> GROUP N[CN�NICAL � <br /> � � I f7YE5 . NO i <br /> ADD1110NAL PLAN CNECN i <br /> F RE AURM REO'D REASON i <br /> N� OTlIER � <br /> i <br /> FlPE SPRINNLER REOD REASON i <br /> �� STPTE OUILDING SIIRCNARGE I "—� <br /> TVPEOFCONST PlANS PROVED9V CITYOFEVERETT �'UBLICWORKS � <br /> �, _,� � �7, LOCAL SALES — � <br /> DATE � Z' / �/ TAX CODE IS 3105 TOTAL /=�� j�j�7 <br />