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( .� <br />,"�� �) .J� ��Z.0 rLl1.'\ <br />APPLICATIOrI FOR CONSTRUCT�JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CE�AR STREET • EVERETT, WA 98201 • 259-8810 <br />n DEMOLITION fl COM8INATION fl BUILDING f� MECHANICAL r� PLUMBING �l SIGN <br />J( PROJECT ADDRESS <br />�2��/ /� S � <br />XOWNER MAILADURESS ' �ITY <br />ZIP PHpN[ <br />I <br />_�,�n �.�. ; , � � , l%-:, � - �� y ., �, _ y 3 ; s- <br />.4 _ � _ � � j = r ._,..� � �� � � Z r; _' <br />TENANT 61111LADORF55 CITY JIP PHONE <br />ARCHITECT OR DESIGNER MAII. AD�FE55 LITY ]IP pHONE <br />XGENER�ICONiMCTOR MAILADItf1E5S CIIY ZIP P�ION[ ti�A7ELICENSE• <br />['l '�-'v' �1 G� /'� <br />MECNANICAL WNTR�CTOR MAII ADOPESS CIN ZIV PIIONE STAiE LICFNSE � <br />PWMBINGCONTRAf,lpp IAAILADDRE55 CIN ZIP PNONE STA7ELICENSE• <br />CON�RACT GRICE OF WORK <br />DESCRIBE WORK AND S�UFRE FOOTRGE INVC' VED <br />i� n`� �� ' � �a�� <br />PROPOSEO USE OF Bl11LDING <br />�LOTALDESGN�RIP,T{ONOFBLOCKERTY��OF���JA"JTwp.�/PJS� � <br />ii <br />O �JJ <br />PARCEL TAX I.D. NIIMBER <br />iC N3��r-3l'Z-��/7-�od "; <br />CONSTRIICTIONLOANLENUER.ADDRESS.TEIEPHONE NUMBER <br />PLUMBING <br />NO. TYPE OF FlXTURE OR ITEM FEE <br />WATER CLOSET ITOILETI T— <br />LAVATORY (WASH BA: <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK ISERVICE — BAR. ET <br />FOR OfFICE USE ONLY: <br />FRONTSETpACK RFAR SFTBACN <br />USEZONE �IU7nREA <br />SUB TOTAL S � <br />PERMIT S --� <br />TOTAL FEE S � <br />SIDE SETBaCN <br />IIEIGHTLIMITATION NOOFUWELLING <br />❑NIIi <br />OCGUPpNCY NO OtS10mE5 OCCUPANTLO/U <br />FIRF SPRINKI FR RGOD <br />PI�N$ �PPRpyFD OY <br />UAIE <br />V�CANLSILE <br />IIYES fl NO <br />size or n�oc;Ri <br />IIVES �1 NO <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />HEATING SYSTEM: f 1 GAS �I ELECTRIC f 1 <br />CONTACT PERSON �ND PNONE ND. <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WI?H WHETHER SPECIFIED HEREIN OR <br />NOT. THE 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 OF THE <br />PERFORMANCE OF CONSTRUCTION. THAT I 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 />CONTRACTORS LP.VJ 1P27 RCW AND 296.200 WAC. <br />X ���-��� �Y��i (a -3� -�� <br />SIGNATURE OATE <br />CITY DUSINE55 LICENSE N0. <br />NO. 7YPE OF EOUIPMEN7 <br />A/C — A/HNOLG UNITS — H.P. <br />FORCEDAIRSI'�fEMS—B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />FIREPLACE INSERT <br />G.4S FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />PlnNC11EC NUMf7F� <br />�1 �a-� <br />owinn+c <br />PLIIM(iWG <br />MECH4NIC�L <br />M1OpiliONM. n�pry GM(CK <br />OiHEfi <br />SinlC PUIlDIN6 SI1Rf,NqfiGE <br />P1191 �f, WOf1N5 <br />TOTAL <br />rer <br />BURNING) <br />SUB TOl'AL 5 <br />PERMIT $ <br />TOTAI FEE $ <br />RECEIPi NO <br />� <br />. <br />