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APPLICA�lL.�1 FOR CONSTRUCl �.�N P��RMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVEHETT, WA 98201 • 259-8810 <br />❑ DE!AOLITION ❑ COMBINATION f] BlIILDING I� MECHANiCAL ❑ PLUN8ING �SIGN <br />PRfiJECT ADDRESS _ . G� _ �—`. <br />c�,�, <br />TENANT � MFILADORESS � / CITV 21P PMONE <br />,�.� d�s A���e _ _ <br />ARCHITECTORDESIGNER MPILADORE55 Clli Z�P NMONE <br />MECHANICAICONTRACTOR <br />000 <br />�RE FOOTAGE <br />CITV ZIP <br />As A,�o✓� <br />CIN ZIP <br />Cltt ZIP <br />��ti'91` X /� u' <br />LEGAL DESCRIPTION O° <br />LOi I <br />� V1 <br />PARCE�TAXI.D.NUMBER <br />CONSTRUCTON <br />PLUMBING <br />NO. TYPE OF <br />WATER CLOSET <br />BATHTUB <br />SHOWER <br />KITCHEN SINK & <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />LOW OR ARACH TWO COPIES� <br />OF <br />TEIEPHONE Nl1MBEfl <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ET <br />Ofl I7 EM <br />SUB TOTAL S <br />PERMIT S <br />FOR OFFICE USE ONLY: <br />fflONTSETBACN RFAR SETBACK <br />� �_ <br />� �' -- <br />USE20NE AREn <br />C� � � �p� <br />HEIGMnUMIT�T�ON N0. OF OYlELUNG <br />` UNITS <br />! J / <br />�� <br />OCCUPANCY N0. uf S I��"•ES OCCUPAN'� 10A� <br />GROUP <br />OF CO4ST. <br />!-/ <br />FEE <br />� <br />STATE LICENSIi Y <br />JINIt <br />HEATING SYSTE 1: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACTPER�ONANDPHONENO. <br />Fn.; . �c-c_ ok1�/ <br />I HEREBY CERTIFV Tt'AT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND O��INANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR C.4NCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAVi REGULATING :.ONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOPM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPIY WITH THE STATE <br />CONTRACT/OR�S LAW 18.27 RCW AND 296200 WAC. <br />i( / .✓"`_�/� /V "�' /S <br />SIGNATUR DATE <br />CITV BUSINESS LICENEE NO. <br />MECHANICl.L <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />A/C —A/HNDLG UNITS — H.P. ' <br />FORCED AIR SYSTEMS — B.T.U. M E.A. i <br />HEAT PUMP ! <br />��.� � ., — <br />CLOTHES DRYEFiS <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE <br />GAS FIREPLFCE <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL 5 <br />PERMIT S <br />TOTAL FEE $ <br />SI�'c SETBAC= PLAN CIIEC M Efl FEE �D RECEIPT NO. <br />Y / e � <br />VACFNTSITE � FEES VALUATION � <br />❑YES /CI NO BUILOING <br />SIZE OF BL�GRI. <br />PLUMBING <br />BASEMENT MECHANICAL <br />❑YES ❑ NO <br />AO�IT10NAl PLAN CHECN <br />OTMER ' <br />STATE BUIIOING SURCHARGE <br />CITY OF EVERETT PUBLIC WOFKS <br />� LOCAL SALES — — <br />) TAX CODE IS 3105 TO7AL <br />� ; <br />�, ; , r <br />J <br />