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APPLICATION FOR CONSTRUCTION PEf;.MIT <br />�ITY QF EVERETT • BUILDING DIVISION <br />32U0 C;EdAFi STREET • EVERETT, WA 98201 • 259-8810 <br />fl DEMOLITION fl COM8INATION fK BUILDING (-I MECHANICAL f l PLUMBING '-i SIGN <br />PqO.fECT ADDRESS <br />/Go3 sa. „�J' Sr G�vo.4 rr w„ <br />ERp MAILAD�PESS Cltt IIP PMONE � <br />_ (/la/I�sGi�oL-.AI-I��r�y !21/� S'(�l`6 Sb �S�t A -.�a�r� `/f'tyo �.76�iS1GP-i9i'lo <br />7ENANT MAILADORE55 r�Ty IIP PHONE <br />�RCHRECTOfl�E51GNER MRII.ADOPES$ GITV 71P PHONE <br />G NERALCONiRACTOR MAl1.A�ORESS CIIY 21P PIIONE STATEI.ICENSE� <br />Y�/� //er/q �'U/,�,t i�T/ �'�oA��,,,s/,,�,, Y8�/ �36oasxl-n.�. NGe�r ?ab.r. <br />MECHANICAI.CONTRACTOR MRILADbRE55 CITV ZIP -- p��j qE STATELICENSE� a• <br />PLUMBiNGWNTRACTOR MAILADDRESS CITY 21P PHONE STATELICENSE� <br />CONTRACT PRICE OF WORK -- - <br />HEATING SYSTEM: f-I GAS fl ELECTRIC f� <br />DESCRIBE WORK AN� SOURRE FOOTAGE INVOLVED CONTACT VERSON ANG PHONf. �!O. <br />2 <br />/+1ST•q/I SiSa4�l.+�q. �.SJ►` <br />PROPOSE� USE OF BUILDING Tr'-� <br />LEG�I UESCRIPTION OF PROPERTV (SHOWN 81 <br />LOT _ BLOCY. <br />PMCEL TA% I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. AOONE55, TEIEPHONE NIIMBER <br />PL.UMBING <br />NO. TYPE O� flXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />i BATHTUB <br />LAVATORY (WASH BASIN) <br />SHUWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URIPlAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — 2AR. ETC.1 <br />`�1S" y+' Y Cc7'�/wy� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT A�.L <br />PROVIS�ONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFfED HEREIN OR <br />iTwocovies) NOT. TH[ GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPc'RTY TO PERPORM THE WORK FOR WNICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />x r? 9 � Qn.: w-.� �/�.y 3/'9 S— <br />SIGT�YURE DATE <br />CITY BUSINESS LICENSE NO. <br />MECHANICAL <br />FEE NO. TYPE OF E�UIPMENT FEE <br />� ' A/C—A/HNDLGUNRS—H.P. � <br />; FORCED AIR SYSTEMS — B.T.U. M E.A. � <br />� HEAT PUMP , <br />' UNIT HEATERS — B.T.U. M <br />� CLOTHES DRYERS ; <br />� VENTILAT�ON FAN �— <br />; FANGEHOOD ' <br />� <br />� WATER HEATER � <br />—� <br />' WOODSTOVE � <br />� METAL FIREPIACE (WOOD BURNING) ' <br />� <br />� FIREPLACE INSERT (WOOD BURN�NG) � <br />i GAS FIREPLACE ' <br />GAS RANGE � <br />' GAS PIPING ' <br />� E%HAUST FAN ; <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL PtiE $ <br />FOR OFFICE USE ONLY: <br />FRONT SFTPACK REAR SETBACN <br />U�.EZONi IO7AREA <br />HEIGNTLIMIiAT10N NO.OFCWELLING <br />UNIfS <br />OCCUPRNCV HO Of510R1E5 OCCUPANiLO/.D <br />GNOUP <br />BY <br />�ATE <br />SIDE SETBACK <br />VACANT StE <br />fIVES f1 NO <br />PUNCIIECKNUMBEF �FEE <br />euan!Nc <br />SIZE OF BLOGRI <br />PWMOING <br />BASEMENT MEClInNICAL <br />fIVES f1N0 -- <br />— �DDI IIONnI. PI AN C�1f CK <br />O711ER <br />STATE Bl11lUIN(i SIIqLMABGE <br />CITY OF EVERETT ruei ir, wonKs <br />LOCALSALES <br />TAX CODE IS 3105 7oTAL <br />PERMIT $ <br />TOTALFEE S <br />RfCEIPT NO <br />