2716 19TH ST 2016-01-01 MF Import

APPLICATII }�1 FOR CONS'�RUCi _aN PERMIT CITY OF EVERETT • BUILDING DIVISION 3200 CEDAR S7REET • EVERETT, WA 98201 • 259-8810 ❑ DEMOUTION /COMBINATION L�BUILDING �MECHANICAL �'f PLIJMBING Cl SIGN PROJECT ADDRESS �� i/ % Q�'!� C�eC;� (� / J ' L OWN R MAILADDRESS CITY ZIP PHONE �,i- �7G� �i�, n a-W� %� `l�� c14Y' /Oii /�8�' s�f: S t�.J �dltril , CtI4. /i� G-/ef TENANT MAILAODRESS LITV 21P PXONE ��/'7�� ��J ARCHITECTOP.DESIGNEH MAILAD�RE55 CITV ZIP PHONE' • �_ . I _. �� _ . � ��ry ZIP P��ONE STATE LICENSE � i ��;�aL ��E E�u�tt-� �a. 9�aos�_. �y��gp MNLADDRE55 CITV � Z�P PHQryE STATE LIGENSE Y PLUMBINGCON7RACTOR MAILAODRESS CIN ZIP PHONE STATELICENSE� OF WORK LEGALDES'C�RIP'TION OF PHUY[niY �anurvn oo�vn � LOT � BLOCN,�_ OF.� �SS 3 J - oo/- a/S"-- PARCELTA%I.D.NUMBER rpR� CONSTiiUCTION LOFN LENOEF, RDORESS, TELEPHONE NUMtlER PLUMBIN6 TYPE OF FIXTURE OR ITEM CLOSET (TOILET) -- io � I.,AVATORY (WASH BASIN) � SHOWER � KITCHEN SINK & DISP — DISHWASHER � LAUNDRYTRAY CLOTHES WASHER — URINAL DR�NKING FOUNTAIN FLOOR DRP BACKFLOW — BAR, SUB TOTAL $ PERMIT $ TOTAL FEE $ HEATING SYSTEM: �GAS ❑ ELECTRIC CI CONTACT PERSON ANp9l�ONE N0. �� .—� i I(J �J n � ASZ i IHEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TAUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICA ION IS MADE AND � COMPLY WITH THE STATE CONTR ORS LAW 18.27 RCW AND 296.2D0 WAC. � X � � DATEL 51 A 11RE A�,oli�e�fio.r iit. CITV BUSIN 5 LICENSE N0. FEE NO. TYPE OF FIXTURE OR ITEM FEE � A/C—A/HNDLGUNITS—H.P. � FORCED AIR SYSTEMS — B.T.U. M E.A. i HEAT PUMP � UNIT HEATERS — B.T.U. M _ _ _ FOR OFFICE USE ONLY: FRONT SETBACK / REAR SETBACK / SIOE SETBACK /l i� �%i0' . USE ZOti� � L' -J VENTILATION FAN RANGEHOOD WATER HEATER WOODSTOVE METAL FIREPLACE ( FIREPLACE INSEPT GAS FIREPLACE GASRANGE SUB TOTAL TOTAL 3 PLl�N CHECK NUMBEN I FEE I RECEIPT NO. // / �.� ) LOTAREA �ACANTSITE r«`� � OYES ❑ NO BUILOING / NO OF UWELLING SIZE OF 9LDGRI. UNITS PLUMD�NG �Jl ` % ��.i �STOAIES OCCUPANTLOAD BASEMENT MECNANICAL ❑YES ❑ NO AODIiIONAL PLAN CHECK R[ASON OiHER O'D PEASON STATE BUILDING SURCIIARGE PLANSAPPROVEDBY CITY OF �EVERETT PUBLIC WORKS LOCAL SALES — ....� TAX CODE IS 3105 TOTAL .