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APPLICATI4■� FOR CON�TRUC? .JN PERMIT <br /> CITY OF EVERETT• �UILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOUTION �l COMBINATION ;� BUILDING �l MECHANICAL I� pLUMBING yX�SIGN <br /> PROJECT ADDRESS �/ I O 1�,�.e �6� �'Q <br /> 10 �� 'l, <br /> N?.'Efi MnitqOnnrss Cltv zir r11oNf: <br /> TtMAnIA��M&N7 2Gi0 U1�ln�_� Q,,�_�����yp��Zv,G z,�y- 3G�S <br /> TENRNT MAILApDR[55 GtY ]IP 1'NpNE <br /> ARCMI?ECTORDESIGN[R AfA1Lqf1�RE55 CITY Zm PIIOkE � <br /> ,GE.�1ERAL WNiR�CTOR MAILA DRE55 CItV )IP P1104f: STAi[LICENSF:� <br /> W/�i���Ei�9l� "�1J7 � �U11dIN� �2�-IIbU TASNi3"A122L2 <br /> MECHANICRI.CONTq�CTOfi MAILA�DRE55 CITV 71P PHOtr[ ST�TFLICEN3F.• <br /> PLUMBINGCONTRRCTOR MAILADORE55 CIiY ZIP PHOVE STAIELILENSE� <br /> CONTRRCT PRICE OF WORN • � ���, — <br /> � HEATING SYSTEM: �l GAS fl ELECTRIC ❑ <br /> �0 CRIBE WORK�NU SOUAPE FOOTAGE INVOWED CONiACi PEPSON�Nb PHONE NO <br /> iVhT,P,aCT ,H�.io �w Ti�r,� nAnlc� F� u��� G a�-r��o <br /> vV �Nic�, � 7,� <br /> p�,��� �-� �7� ���� �� Q�7 I HEREBY CERTIFY THAT I HAVE REA� AND EXAMINEO THIS <br /> PqOPOSE0U5E0F0UILDMO Y APPLICATION AND KNOW iHE SAME TO BE TRUE AND CORRECL ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> WORK WILL BE CONPLIED WITH WHETHEH SPECIFIED HEREIN OR <br /> LEGIILDESCNPTIONOFPROPERtt�SHO�VNBELOWORRTiAGHTWOGOPiES� NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior e�ocrc oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> f ERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APP�ICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEITA%IA.NUMBER CONTRACTORS W 1827 R�jW' AND 296.200 WAC. <br /> CONSiRIICTIONLOPNtENOER,ADDRE55.iElEPhONENUMBEi1 ���� �G.�IAIIlRM 2-{7.�C� <br /> Cf�VW V Y V <br /> _� SIGK�A URE O�IE <br /> __— CItY PUSINESS IICENSE NO. <br /> PNMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) HEAT PUMP , <br /> SHOWEF � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES ORYERS � <br /> DISHWASHER � VENTILATION FAN i <br /> LAUNDRYTRAY ' RANGEHOOD <br /> CLOTHES WASHER � WATER HEATER <br /> URINAL WOOD STOVE <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GASFIREPLACE ' <br /> SINK(SERVICE—BAR, ETC.) GAS RANGE � <br /> 6AS PIPING <br /> EXHAUSTFAN � <br /> i <br /> i <br /> �— <br /> i <br /> SUB TOTAL S ' SUB TOTAL S ' <br /> PERMIT S i PERMIT 5 i <br /> TOTALFEE 5 � TOTALFEE 5 � <br /> FOR OFFICE USE ONLY: <br /> �RONTSETBACK REMSETOACK SIDESEifinCK PIANCUECKNU-M�OF9 PEE RECEIPiNO <br /> O v' J 7(�/�� _�S. /D //�3� c� <br /> usezor+e \ i.ornnen vncnr�rsire FEES VALUATION FEE <br /> �,J f7YES �NO OIIIl01NG � i_ <br /> HEIGMTLIMITRTION NOOFUWEILING SREOFBLDG/fl. <br /> �11�(F Un175 fWMi)ING <br /> V � <br /> OCCUPANCY NOA[StONIES OGCUPANiL0a0 BASEMENT i <br /> GROUP M[CNANICAL i <br /> f1Y�5 fl NO � <br /> i <br /> FIREAURMqEOD qG50N AD�171ONnlPLANCH[CK � <br /> OiH[R i <br /> FIRE SPRINKLER REO'D RFASON <br /> � <br /> STA1E�UILOINO SURCNAIiG[ � <br /> IJ <br /> TVPEOFCONST PlANSA PqOVE00V � <br /> �ti� CITV OF EVERETT runnr.wonKs <br /> � LOCALSALES � <br /> p�T� `� . �}�y S TAX CODE IS 3105 70TAL / ;i— � <br />