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.�.. <br />APPLICATI4� EOR CONSTRUCT�vN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION �/ <br />320J C�DAR STREET • EVERETf, WA 98201 • 259•8870 <br />fl DEIAOLITION fi COMBINATION f� BUILDING I� MECHANICAL �PLUMBING fl SIGN <br />PROJECT ADDRESS '"'j <br />Z�O/ ✓/R!//.�//� f)!/c--'. � c'�( E7'%i GfJfi' "%f'Z��/ � <br />!� <br />AiCNITECTOR0E51GNER Ma�nppRE55 <br />nr <br />..�..�._� �-..iii.�iivN .�r �i �� cC�GI�Y /YVE'• E-!lt����LU/J %YJLU/ (C(1G���%" j�=j� <br />�iNmaiCONrnncion iu,o.nonness cirv ;m r��o��e ' srnreucrNse. �-Z�iT <br />�1c:o,u�ItiC, id/6�/l7A�iti� �iE��i�����,���l�.�o/ �1���252��f1 /SBe <br />MEUI�NICALCONTRACTOR MAILADDRF55 dtt 71P p110NF. $iAiF:IICE.VSF� <br />PLUMBINGGOhIRPf,IOR M41L4DDRE55 CRY ZIP PIIONE StAIELILENSk.�gjENE � <br />��t/G-2 Q�c�i.��,c�_�,�i/7Ch'�f''av,e0. E fti5' c��� �vg 96'�7��2�4��"�-9a.�i �9oB� <br />for+rn�cr anicE or wosK . — <br />y�7�, � fT�'X HEATING SYSTEM: I 1 GAS f 1 ELECTRIC f 1 <br />DESCRIBE WORR �ND SOUARE FOOTnGE INVOWED WNiACT PERSON nN� PMONE N0. <br />nF <br />�ecn� oescnivnau oF rnori <br />ior eiocK <br />I HEREBY f.FRTIFY THAT I HAVE READ AND EXAMINED TNIS <br />APPLICAi ION AND KNOW THE SAME TO BE TRUE AND CORFECT ALl <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILI. BE COMPIIED WITH WHETHER SPECIFIED HEREIN OF <br />LOWORATTP�NTWOCOPIE51 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />or 4UTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULAT�NG CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICIi <br />APPLICAT N IS MADE AND I COMPLV WITH THE STATE <br />CONTRl�TORS LAW 1827 RCW AND 296.200 WAC. <br />CONSTqUCTION IO�N LENDEA. FDDRESS. TEIEPMONE NUMBER <br />NO. TYPE OF FlICTURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />'f� LAVATORY(WASH BASIN) <br />SHOWER <br />/ K�TCHEN SINK 8 DISP <br />FLOOF 09AIN <br />BACKFLOW PREVF.!:TERS <br />SINK (SERVICE — R.4R, ET <br />fOTAL $ <br />� 5 <br />_ -EE 5 <br />FOR OFFICE USE ONLY� <br />fRONTSFTPACK PF.RR SFT04CN SiDE SETOACN <br />USE ZONE � lOUf1Eq � en <br />HEIGIIT UMIiRiION <br />FEE <br />[�If� <br />NO. <br />HNDLG UNfTS — H.P. <br />AIR SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />ATER HEATER <br />WOODSTOVe <br />METALFIRE?LACE(WOODI <br />FIREP�^.GeINSERT(WOOD <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />Pl /.N CI IECK <br />^,n <br />nunnirvc <br />NO OF UWCIUNG 511[ O� i'. <br />IINIIC <br />PlUM014G <br />IX:CUPANL lOA[1 BRSENENL M[C�IRNICnI <br />IIYES ilpp <br />RP�SON �DUi1lNlnl. PI AN CN[GK <br />O�MER <br />nEncoN <br />smie nmiorvc sune��nnce <br />rinNsarvnovennv CITYOFEVERETT �umir.wonK� <br />LOCALSALES <br />unic TAX CODE IS 3105 TOTAL <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTAI FEE S <br />FE[ �RECEIPiNO. <br />