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,•� _ � <br />APPLICATIt..�l FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION Cl COMBINATION fl BUILDING I� MECHANICAL f 1 PLUMBING f-1 �IGN <br />PROJECT ADDRESS <br />_� ��y <br />y�or.. o i v 2�0 Z SC-� ^�: SW Y <br />TENANT MAILqC]PE55 CIP! <br />APCHITECTORPESIGNER� MAILAO�PESS CITV <br />w� ,�I.� - <br />1 <br />�',(p�'� Cs..op <br />MAILADDfiE55 r <br />��s 25517 N5 <br />MAILADDFE55 <br />1 <br />�� r <br />MAIL ADORE55 <br />4 <br />LEGAL DESCFIPTION OF PBOPERTY <br />wr ��- e�ocK _ <br />PARCELTA%I.D.NUMBER <br />CONSTFUCiIONLOqNLENOER.ADDRESS.TELEPHONENUMBER <br />PLUMBING <br />NO. TYPF nF F�mmc no irv.. <br />v u�� A-r�o,� � as�o <br />0 N ��a � s a`��. o� <br />/�no rGo �1 � �9. S s.�.) <br />SUBTOiAL S <br />PERMIT S <br />TOTAL FEE S <br />l.IP PIIONE <br />PHOHE STATE LIGENSE a <br />ZIP PHONE STATELICENSE1r <br />HEATING SYSTEM: ❑ GAS Cl ELECTRIC ❑ <br />� I,.,,.,..,.,.�..�,,,.,.,.,,.,.,,,.�- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APrLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS 1 YPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AtITHORITY TO VIOLATE OR CANCEL THE PR(1VISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEFFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FpR WHICH <br />APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18/.R7 RCW AND 296200 WAC. <br />I�-�, �^/ �✓L ��lA' %S <br />X <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO. <br />M�CHANICAL <br />'EE NO. TYPE OF FIXTURE OR ITEM <br />� A/C—A/HNDLGUNITS—H.P. <br />; FOfiCED AIR SYSTEMS — �.T.U. M E.A. <br />� HEAT PUMP <br />' UNIT HEATERS — B.T.U. M <br />� CIOTHES DRYERS <br />� VENTILATION FAN <br />; RANGEHOOD <br />� WATER HEATER _ <br />' WOODSTOVE <br />i METAL FIREPLACE (WOOD BURNING) <br />� FIREPLACE INSERT (WOOD BUR�IIN <br />; GAS FIREPLACE <br />GAS RANGE i <br />! GAS PIPING <br />FOR OFFICE USE ONLY: <br />FRONT SETBAC � REAR� ACK � SIDE SETBAC(( / PLAN CIIECK NJ1M0; R� <br />P . � �-1,�� � ' � <br />USE20NE LOTAREA VFCANTSITE FEES <br />_ � �S flVES f� NO OUILOING <br />HEIGNTLIMITATIOq � UNI SfOWELLING S¢EOFBLDGIfI. <br />rJ 'A� PWh'�ING <br />!I'�7� (J S f. �1f7VJ1 ( 0�1 <br />OCCUPANCY NO.OFS70NIE5 OCCUPANiLOAD gASEMENT <br />FIRE SPPINKLER R <br />�0 <br />� � h1ECH�NICAL <br />❑ YES IYNO <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE O111L01NG SURCHARGE <br />CITY OF EVF,pETT ruoucwonKs <br />/ LOCALSALES <br />TAX CODE IS 3105 TO7AL <br />FEE <br />� �• � <br />S B S � <br />PER 5 i <br />l'OTAL FEE S � � <br />/ � RECEIPT NO % <br />� /J �/ �t��?/ <br />0 <br />. <br />