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APPLIC�lTld�l FOR CONSTRUCT�ON PERiN1 T <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STR�ET • EVERETT, WA 98201 • 259-8810 <br />C] DEMOLITION COMBINATION rl AUILDING C7 MECHANICAL I-1 PLUMBINQ fl SIGN <br />PROJECT ADDRESS I-Z�� �^,Uy� ^,, c �, C' I��^ I <br />iJ ✓lY �$t� J. CN 'r`t" <br />OWNER M�ILAOONESS CITY ZIP PHONE <br />iENIWT + MI1IU�DRESS QTY ,'I ZIa FHONE <br />J <br />ARCNITECiORDESIGNER M�ILAO�RESS CITY ZIP PHONE �:•. <br />�ENER�LCONTR�CTOR MAILADDRE55 CITV 21P PHONE STATeLICENSE/ <br />VLUf�MBII,OpV'ONIRACTOR �ARIL�DDRE55 � CITY <br />CONTRACT1,•IC�FViORK I ��� 1 ��� �' �•� <br />J <br />�OESCRI E WORK AND S�U�RE FOOT�OE INVOLVED � <br />nmo.aru� � , i ny.� <br />����. �► � i i9a <br />vaovo,s�eo��o�^Feuikoi�a„ . , <br />� LW M�1 Gk. <br />LEOAL DESCHIPiION OF PROPERTY (SMOMM BELOW ATT H OPIESCt _ � = <br />lOT'�_ BLOCK � OF 1'IXIV\A..� <br />�.� �Yw��e S e Y <br />PARCEL TNf I.D. NUMBF$ _��' ��`' � 1 <br />ai S <br />CONSiRUC770N IOAN LENDER,110DRE55, iELEPHIXJE NUMBEP �� <br />TYPE OF flXTURE OR <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY(WASH AASIN) <br />SHOWER <br />KITCHFN S:: IK & DISP <br />DISHWASHER �� <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKINa FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ETC.) <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK RE�R SETBACN <br />2o Zo <br />USE ZONE � � LOT�A �� <br />@ <br />lIEIG/ITLIMIT'TIOQN � UNIISDWELLING <br />�—U � <br />OCCUP�NCV NOO�SfOnIES OCCUPMITLOAD <br />GROU <br />rzs ua y <br />REO'U <br />'/J I DATE <br />TOTAL S <br />SIDE <br />:' t t <br />ZIP PHONE STATE:ICENSE� <br />� ' <br />HEATING SYSTEM: Ij�GAS fl ELECTRIC fl <br />� I HEREBY�CERTIFY�THAT I HAVE REAO AND�E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br />��� NOT.'THE ORANTINO OF A PERMIT DOES NOT PRESUME�TO 61VE <br />ii AUTHORITY T� VIOLATE OR,CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REOULATINQ CONSTRUC?�ON OR �THE <br />PEHrORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY Tf 1E <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTfiACTORS LAW iB27 RCW AND 298200 WAC. <br />!��t lc'Y,P/P� <br />�ION RE DA� <br />CITY BUSINE55 LICENSE NO. <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />T <br />A/C —AMNDLO UNRS — 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 i <br />VENTILATION FAN � <br />i <br />. ::�i 1'r��^.t� '� �.;' �.i �? �+p ' RANOE HOOD i <br />� WATER HEATER � <br />� WOOD STOVE ' <br />i�� 3' i i^�I �. METAL FIREPLACE (WOOD BURN�NG) �_ <br />� FIREPLACE INSERT (WOOD BURNINO) � <br />' 6AS FIREPLACE � <br />i <br />� DAS RANOE � <br />' GAS PIPINQ ' <br />� E%HAUST FAN ! <br />PLANCIIECKNUMBER FEE <br />53� SbJ <br />VAC�NT SITE reea <br />ES fl NO BUILDING <br />)F BIDOR.I <br />� S,F. Q�� E�' pLUM81NG <br />BASEMEMT � � MECNANIWL <br />fIYES IWNO <br />AODIiIONRL PUN C��ECN <br />OTNER <br />� STATE BIIILOMC SURCHARGE <br />CITY OF EVERETT Pueur.wonKs <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUBTOTAL� S <br />PERMIT S <br />TOTAL FEE S <br />RECEIPT NO. <br />C <br />.no <br />