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APPLICATIOrI FOR CONSTRUCT�ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION fl COMBINATION i:l BUILDING R MECHANICAL r1. PLUMBING f1 SIGN <br />PROJECT ADDRESS , <br />� ✓ - <br />ONTIER MRILA�ORE55 CI1' ZIP PMONE <br />! 1 _ � .� <br />_t,�/�:'��'i. .,�.- ' .c_��L .,c s _"� r�. il�_a _:i_����3r:.Y,�.—'<' <br />TENANi `MAI�FDDRFSS �� CRY , 21� � PHONE � <br />ARCHITECT OR �ESIGNEP MML A�DRE55 GITY ZIP PHONE <br />.6:�,_ �..rrr 4��;�ir�' �� l-;•-•�r,��� -- <br />GENERALCONTPRLTOR MAILAUDRESS CRV l.i^ PHONG StAIELICGNSE� <br />L.C-'�l�.,c{Cl/i(�' /�,�� .iC 4'�/��<)' _'/' :9. - �.`. i� ir-i^Y.,��! �%%� �2'.�1}JO�h.r71i'%/-/ <br />MECNANICALCONTRACTOR ' MAILAQDRE55 CITY ZIP PIIONE SiA7EUCF.NSE+ <br />GLUMBINGWNiRACTOR MaILA0DRE55 GIiY ZIP FHONE STAIELILENSE� <br />pF WORK <br />�ESCRIBE WORK �NU SOIIARE FOOTAGE INVOlVEO <br />PROPOSED USE OF BUILDING <br />�OT � �� BLOCN T��'�' (� <br />OR ATTACH TWO COPIES� <br />�! ! �,��/r:�c t �i <br />x 1�(�� I <br />CONSTRl1CT10NLOANIENU[H,A��PESS.TELEPMONE NUMBEP <br />[ �.r/.;�1'.�o--L' /.�d<:�.�U4.ct �� _ _ '`-� ) 7j'< - ���f—, �' _ <br />_. _ — _— <br />,, <br />,',"v�i! = � r`I" � �r S � �' �(csi!%::u=� �- j�J:•�� � <rc�� <br />PLUMDING <br />NO. TYPE OF FIICTURE OR ITEM FEE <br />/ WATER CLOSET�TOILET) <br />BATHTUB <br />( LAVATORY (VJASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DI.iP <br />/ DISHWASHER <br />LAUNDRYTRAY , <br />CLOTHES WASHER <br />URINAL _ <br />DAINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />cwr �caavir.F — ana FTr, i <br />SUB TOTAL S <br />TOTALFFE $ <br />FOR OFFICE USE ONLY: <br />fRONTSETPACI( j� f FEARSFTB CR <br />/� � <br />USE20NE� � IOTAREA <br />i <br />HEIGHT LIMITATIOP' NO.OF UWELLING <br />�•� J UNIfS <br />G <br />OCCUPANCY NO O�StONES OCCUPANTL040 <br />fiROUP <br />o _Z 2- u /a <br />1V � <br />TYPE OF CpNST <br />ncpN <br />DATE 1 <br />BY <br />� f SIUE SETBACN l <br />Vr1CANI SIiE <br />f1YE$ fl NO <br />SIZE 0� OLDGrtI <br />IJh"1 SF �-Ivi�J4 �Y <br />� <br />BASEMENi <br />iires u�� <br />CITY OF EVERETT <br />LOCAL SAIES <br />TAX CODE IS 3105 <br />HEATING SYSTEM: J1GAS f� ELECTRIC �l <br />CONTACT PERSON AN� PHONE NO <br />..(�.�, �s' j "..G %��C� <br />I HEREBY CERTIFY THAT I HAVE REAC 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 WI7H WHETHER SPECIFIED HeREIN OR <br />NOT. THE GRANTING OF A PERMIT �OES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFCRMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEC BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE W�IRK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X �%!��cr/.�%---�'c'r. I -. �.i�� /..Z —( '.< _.CI-.:� . <br />SIGNAIUFE '�� DAiE <br />��z%��G <br />CITY BUSINESS IICENSE N0. <br />MECHANICAL <br />NO. TYPE OF E�UIPMENT FEE <br />�— <br />A/C — A/HNDLG UNRS — H.P. ' <br />FORCED AIR SYSTEMS — B.T.U. M E..4. ; <br />HEAT PUMP � <br />UNIT HEATERS — B.T.U. M ' <br />j CLOTHES DRYERS � <br />f VENTILATION FAN ' <br />/ RANGEHOOD � <br />— �— <br />� WATER HEATER � <br />WOODSTOVE ; <br />METAL FIREPLACE IWOOD BURNING) � <br />GAS FIREPLACE <br />GAS RANGE <br />EXHAUST FAN <br />SUB TOTAL 5 <br />PERMIT S <br />TOTAL FEE 5 <br />PL�NCIIECKNUMAGR FFf) � /9 RFCfIPiNO <br />� ., �. .. �r ..0 /S 1/ Y / <br />am�mHe :71 Cv� 9 (O � Lo0 <br />rwi.+niuc L�---F..... <br />n�f.CnnNlf.a� �Q iLj, � <br />nnonior+ni. vi.na c��ccK . <br />on�en <br />srme nminr+c sur�cnnnce I I e! ��- <br />run� ir, wo�rcs <br />TOTAL <br />}> <br />