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r--- <br />� �� ,�, <br />' APPLICATIOiV FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA g8201 •259-8810 <br /> fl DEMOLITIOI; fl COMBINATION fl BUILDING 1-1 MECHANICAL f� pLUMBING SIGN <br /> PROJECT O.JDRESS <br /> Iln I�l /9 � /�� � <����� �k� �/<z, ) <br /> OWNER �, MAI�ADDRESS <br /> ,�-�- 1- /' 7L�,, / ��/TM� Z�� PHONE <br /> �ic9 I I B! C1 ( O, �i i✓ ��\/hrn//�/I 'VJ � �� �� lLl <br /> 7ENANT MAILAODRESS �,� � � <br /> �/�' O CITY ZIP 1'HONE <br /> " �/P n`I'�P S��✓rr Lc(L� / /i.zc <br /> ARCNITECTORDESIGNElR MFIIl.AUOREMbS� / / ��ry <br />� �� / lJNC II-�1� / 'V/L•I� J�dJ./ 21P PHONE <br /> _ � ..�....,,iOfi MAILADORESS r M���l�"° 9sr�5s �S�J�y �PA�A�>7�µ <br /> .. �� CIiY • a� <br /> �� ZiP PIIpNE SiAiELICENSEe <br /> 4 MECNANICALCONTPACTOF MRI�AOORE55 CITY 2! PIIONE STAiF.LILENSE� <br /> I PLl1MBING CONTRA�TOR��OORE55 ��iy Z�P <br /> ✓�j� PHONE STATE LICENSE• <br /> i CONTR�CT VRICE OF VIORK �/ <br /> '� ( �a0 vV HEATING SYS7EM: fl GAS I-1 ELECTRIC f� <br /> DESCRIBE YIOPK AND SOURRE FOOTAGE INVOLVED CONTACT PEPSON AND PMONE NO. <br /> � /k W. ino., f: �,' .3SS-Ofs.25� <br /> =5'—�^-5 �i// �. �,A� <br /> � HEPEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED'1SE OF BUILDINQ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � �k,(w�� j�, PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF ' <br /> LEGALDESCqIPT10NpF7ROPERTY�SHOWNBELOWORATfACH7WOCOFIES� W�RK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRAN7ING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ��T BLOCN aF AUTHORITY TO VIOLATE OR CANCEL THE FROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULAT�NG CONSTRUCTION OR THE <br /> _ PERFORMANCE OF CONSTRUCTION.THAT:AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> Pu�CEI T�lc I.D.NUMBER CONTRACTO�g LAW 1B2 R Q296200 WAC. <br /> � ` J <br /> CONSTRUCTION LO N LENOER.ADORE55.TELEPHONE NL'MBFR x C �� ��-L� G�- <br /> �/� SIGNRTURE DATE <br /> CITY BUSINE55 LICENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> � NO. TYPE OF FlXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) � q/C—q/HNDLGUNRS—H.P. � <br /> ' BATHTUB ; FORCEDAIRSY3TEMS—B.T.U. M E.A. � � <br /> LAVATORY(WqSH BASIN) i HEAT PUMP � <br /> SHOWER ' <br /> ' UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN <br /> LAUhDRYTRAV i ' � <br /> � RANGEHOOD i <br /> CLOTHES WASHER � WATER HEATER <br /> URINAL ' WOOD STOVE , <br /> DRINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) � <br /> _ FLOOR DRAIN � FIREPLACE INSERT(WOUD BURNINGJ <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SIIJK(SERVICE—BAR. ETC.) � GAS RANGE � <br /> � <br /> ' GAS PIPING � — <br /> � EXHAUSTFAN � <br /> � T <br /> SUB TOTAL $ ; SUB TOTAL $ � <br /> PERMIT ' <br /> $ ' PERMIT $ , <br /> TOTALFEE $ � TOTALFEE $ � . <br /> FOR OFFICE USE ONLY: <br /> FRONT SETAACK PEFR$ETBACK SIDE SET9ACN PLAN CIIECR���� FE�/ �J fi[CEIPi NO <br /> usezoN��jj ioraaE� vecnNrsrte PEES VALUATION FEE <br /> ` _� I IYES f 1 NO ppILDWG <br /> � <br /> HEIGHT UMITFTION NO OF DWEILING SIZE OF BLOGRI � <br /> 11NlfS <br /> PtUMpING � <br /> i <br /> OCGUP�NCV NO OPSIOFiES OCCUPANTLUR� BASEMENi � <br /> GROIIP MECHnNICPt � <br /> fll'ES tl NO <br /> FIREAURMREO�D REASON rtpOIIION�LPLONCNfCK <br /> _' __7_'- <br /> FIRF.SPPINNLER�F.O'D RF�SON OiN[R <br /> Sinl[AIllL�ING SURCIIMGE ; `� i <br /> TYPE OF f,pNST PL�NS APP VED AY - <br /> � � CITY OF EVERETT runi ic wonKs — � <br /> LOCALSALES —_L— <br /> un7e Z - $..9j TAX CODE IS 3105 70TAL � . � <br /> �� <br />