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APPLICA7'IG / FOR CONSTRUGT�JN P�,F'�Nfili( � <br />CITY OF EVERETT • BUILDING DIVISION GCAr�E� <br />3200 CECIAR STREET • EVERETT, WA 98201 • 259•8810 � T <br />❑ UEMOLITIOM f 1 COMBINATION DQ BUILDING I 1 MECHANICAL f I PLUMBING f-1 SIGN <br />PROJECTADDRESS �123 �irdAvcul <br />CP1lNC'n�JF 3�QD/IU�.W, �5�STpL.S.w. �Vc2�7' /.�,�. <br />owr�En rna�aooness cin zir vuor�e <br />�TE�AN &Olowi�N �r4G GlokcR Ur. �va�[�Tco 9�27y (�6I398 -5353 <br />TENnr�r rani�nou�Ess cm ziv rr�oNE <br />nncwTecr or+ <br />�Ecr <br />MECHANICALCGNTPfCTOR <br />SdNE d5 AFSo <br />MNL�ODRE55 <br />�� ro <br />MAIL �DURESS <br />cm m� <br />i;ir,—� zir <br />CITV ZIP <br />PNONF <br />�R # <br />J <br />LICENSE � <br />PWMBINGCONTF4CTOR MAILA�ORESS QiY LP PHONE STATELICEkSE• <br />WN7PACT PRICE Of WO�N <br />/d5, a�o. - <br />�ESCBI�E WORH AND SOUARE POOTA6E INVCLVE� <br />S��L� FitM. �?�-s�D. !-5; <br />29�o sF��N"�., 5nncc � 3� <br />Su�/ ,�Ec.� ovE2 Gi��Fi1�iE <br />PPOPO ED USE OF BUILf11NG <br />�KG <br />LEGALDESGnRIP��`F LOCK ����OF—p <br />a <br />�SNONYIISN GOUNTy—TE�j�/Z �� <br />5E%j_ r�= sc"GT. � 34-.7vw <br />iL6/vt.i : �FE�dSf WN/.'.EKLc�I <br />7rlE�of � c�rr oF�vE2�r <br />PANCELTA%I.D.NUMBGR <br />CONSTPUCTION LOAN LENDER, ADORE55. TFIEF HONE Nl1MBER <br />OF <br />_J8275 ��.(2�6�95 20�� <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />1 WATER CLOSET (TOILET) /� �/ ! <br />LAVATORY (WASH BASIN) // <br />SHOWER � <br />KITCHEN SINK 8 DISP — <br />DISHWASHER —� <br />LAUNDRYTRAY - <br />CLOTHES WASHER — <br />DFiINKING FOUNTAIN <br />FLOOR DRAI� <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, El <br />FOR OFFICE USE ONLY: <br />FFONTSFTBACK 5ff(� RE�l75GT�ACK <br />,� <br />USE ZONE <br />�` S <br />HEIGHT�IMITATIOQN r <br />2(_i <br />OCCUPANCV NO Of', <br />GROUP � <br />HRE AIAPM REO'� <br />N� <br />FlRE SPPINNLER REO <br />Nv <br />TYPE OF CONST <br />TT_, i <br />SUBTQTAL 5 <br />PERMIT S <br />TOTAL FEE S <br />IOTAREA <br />i 2, (�02 <br />rvo. or oweuu�c <br />��,iTS <br />DATE <br />�rv�+oveo ev <br />J*� <br />SIOE SETDAfN <br />i j� 3yro�ai'' �.S <br />VAC�NT SITE <br />HEATING SYSTEM: f�(i GAS I� ELECTHIC ❑ <br />GOtlTACT P[PS�N AND PHONE ND. <br />1 HEF[B'f CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIO'�:� OI' LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK 4JILL BE COMPLIED WITH WHETH[R SPECIFIED HERcIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESIIME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEI. THE PROVISION OF ANY <br />CTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br />PEHFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATIO IS MADE AND COMPLY WITH THE STATE <br />CONTRAC.T RS LAW 18.27 R�W N 2962U0 WAC. /' <br />I/ I� _ _ " � /v�4 (J � ! / <br />x <br />SIGNATU OATE -- <br />CITV �USINESS UCENSL NO. <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />A/C —A/HNOLG UNITS — H.P. <br />/ FORCEO AIR SYSTEMS — B.T.U. M E.A. <br />HEAT Pl,'MP <br />UNIT HEATERS — B.T.U. M <br />CLOTNcS DRYERS � <br />�" VE�TILATION FAN <br />T RAIJGE HOOD -� <br />VIATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNINGI <br />/ FIREPLACE INSERT jWOOD BURNING) / � <br />� GAS FIREPLACE / <br />GAS RANGE <br />GAS PIPING <br />� EXHAUST FAN T/I ( <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE 5 <br />PLAN CII[CK NUMOGR� �E�� (. J� <br />c-l(�3�f J l — <br />�,:w[s n No o��itowc <br />)P L G.4 <br />�� �F �'�V�N�' PWM�ING <br />jij$ $,Y, AR�I4C <br />P�SEMENT � � MECHANICAL <br />f7 YES I{✓NO <br />CITY OF EVERETT <br />LOCALSALES <br />Tl�X CODE IS 3105 <br />ADDITIONAL PLAN CHECN <br />OTIIEP /�l1U011) <br />. � �� <br />STATE OUILDIKG SIIRCHARGE <br />PU'+IIC WOfiKS <br />TOTAL <br />