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APPLICAT14�n1 FOR CONSTRUCT �ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />��� DEMOLITION fl COMBINATION fl BUILDING Il MECHANICAL rl p�UMBING NSIGN <br />PROJECT ADDRESS <br />�/C� l.c.�cst �'�Ia�,�re l�,e� Qr�✓e jan�H- ,.�„ Q�o�d6 <br />r+ <br />unn nnooaFss <br />-f--t- <br />� z1-�� <br />7iP PNONE <br />�Ma✓'uSuiIIP, �C.� <br />lIT- n��nNc <br />PLUMBINGCONiRRf,TOR MAILADURESS CI1Y 21P pNONE STAiELICENSE• <br />OF WO(1�y <br />''p a c.�a o 0 <br />1N� SOU�RE FOOTAGE INVOLVED <br />. � r� <br />LOT BLOCN <br />PMCEL TA% I.O. Nt1MBEF <br />CONSTRUCTION LO�N lENOER. �WRE55. TELEPIIONE NUMBER <br />PLUMBINO <br />NO. TVPE OF FlXTURE <br />WATER CLOSET (TOILE� <br />BATHTUB <br />LAVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINK R DISf' <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ET <br />1� <br />HEATING SYSTEM: I 1 GAS �l ELECTRIC f l <br />CO�+TACi PF[\i SON �NO PMONF NO 1 /� ('�� <br />�1 JVo�.c, (_�T'e�n �7T^�%. <br />�.� • <br />�+�� 1 HEREBY CEFTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME 1'O BE TRUE AND CORRECT ALl <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO V�OLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW PEGULATING CONSTRUC710N OR THE <br />PERfORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZFD BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br />CONTqACTORS LAW 1827 RCW AND 296.200 WAC. <br />x _�•.�-c�0 �-� � ( - � - �t S <br />SIG�URE DAIE <br />CITY �USINESS IICENS[ NO <br />MECHANICAL <br />OR ITEM I FEE <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETPACK � PEAlISETBACK <br />, O S U� � <br />USE IO,�IE, � lOi RREJ� / � <br />�V\i f7fl� <br />'101y NO OF DWEILIjN <br />� , UNIIS / <br />ND Oi SIORIES OCCUPAM L04� <br />SIDE SETBnCN <br />� 0 / <br />� v�cnNrs�re <br />fIVES <br />TYPEOP�ECUIPMENT �FEE <br />A/C — A/HNDLG UNITS — H.P. <br />FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE ( <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />PERMIT $ <br />TOTAL FEE $ <br />`IA�� / N�/R I fEF/� �a I FECFIPTNO. <br />�' "� BUILDING <br />SIZE OF OIOCRi <br />lVPFOFf,ON$T f'1�N5��laOnVE-DOY <br />In . � <br />P111M[iING <br />RSEMENT MECHANICAL <br />f1VE5 (i NO <br />ApDI110N�L PI�N CNf.CK <br />Oi11ER <br />Si�TE OUILOIYG SURCII�(iGE <br />CITYOFEVERETT ruriir.wonKs <br />LOCALSALES -- <br />TAX CODE IS 3105 TOia� <br />