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l�►PPLICATIfi.� FOR CONSTRUCT .ON PERNliT <br /> CITY OF EVERETT• BUI�DING DIVlSION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 • 259-8810 <br /> (-I DENOLITION �l COMBINATION fl BUILDING FT MECHANICAL r 1 PLUMBING I 1 SIGN <br /> PROJECT ADDRESS <br /> LF I _ J(5� 17 r-f'�,o /.( � #' �� <br /> �oW -f/- / MAlI.rlppRh55 cin zm PHON[ <br /> C.C� Y�V/�-�� <br /> TEN�NT M�I�ADORESS CITY ZIP PIIONE <br /> ARCHITECT OP OESIGNER MAIL AOORE55 CITY liP PMJNE <br /> GENEf1ALCONi(IACiOR MAILA�pqE55 CRV 71P PIIONF. SfAIEIIL[NSf:� <br /> �MECHANICALCONTR(M1�G�TOfI MAIL�/D'DRF55 �1��J Qtt ZIC PIIONE SThTFUCEN(S�Ev <br /> �(`/.T�Ph' l''!/1 1 �d/ �q/�L.Y')��� - A�Ci(��M yU(JOO J'tY D ( f'Ml( /�L�/��/T/y��/�/ <br /> � P�UMBINGCONiRAf,TOR ILAD�RESo � CITY ZIP PNONE giAIELIGENSE� <br /> CONTIi�CT PRIC[OF WORK <br /> HEATING SYSTEM: I 1 GAS �l ELECTRIC f 1 <br /> UESCRIBE YIORN AN 5011 RE FOOTA INVO�VE CONTACT P[RSON AN�PI IONE NO <br /> J.� P �, �' �„ _ � , <br /> � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PPOPOSED USE OF�111LDING APPLICATION AND KNUW THE SAME TO BE TRUE AND CORRECT ALL <br /> A PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALOESGNPTIONOPPROPERtt�SHOWNdELOWOPFTfACHTVJOCOPIES) NOT. THE GRAN7ING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> . �or BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PflOVISION OF ANY <br /> OTNEF STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTFlUCTION.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 /> PAqCELTA%ID.NUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUCTION LOAN IEN�EP,ADD(iESS.TElEPHOYE NUMCEF � <br /> X �-�-i�. <br /> SIGNATUPE DATE <br /> tl.� s/i — <br /> CITV BVSMGSS LICENSE NO. � <br /> PLUMBIHG MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATBR CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. � '� <br /> ' BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' i, <br /> LAVATORY(WASH BASIN) � HEAT PUMP � '� <br /> SHOWER � UNIT HEATERS—B.T.U. M <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNORYTRAY ; RANGEHOOD � <br /> � <br /> CLOTHES WASHER � WATER HEATER <br /> URINAL ' WOOD STOVE <br /> DRINKING FOUNTAIN i METAL FIFEPLACE(WOOD BURNING� � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOO�BURNING) <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE , <br /> ; GAS PIPING � <br /> EXHAUSTFAN ; <br /> � , <br /> � <br /> SUB TOTAL $ ; SUB TOTAI 3 <br /> PEfiM1T S PERMIT 5 � <br /> TOTAL FEE S TOTAL FEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETOACK FEARSFTOACN SIOESETBACK PIANCHFCK f [ft fEF qECFIPINO <br /> � �'ao ' <br /> uSEzoNE IOTAREA vaca��rsire FEES VALUATION I°EE <br /> _ i i ves �� �o oun.nwr, ' <br /> I <br /> HEiGHTLIMITATION NOOFUWEILING SIZEOfBLUG�TI — <br /> IIN17$ PI.IINAING � <br /> OCCUPANCV NO O�SfpqiES OCCUPANTLOAO BASEMENi I <br /> GROUP M[L114NIf.�L i <br /> IIYES �I NO � <br /> FlqEALARMREOD RFq50Y �f1UI11pN�I.PIANCHF.CK <br /> OfNEfI � <br /> FlRE SPRINNI.F.R REO'0 FFASON <br /> slme ouaoi+c suncimnce ; <br /> ttreorr,oNsr vtn�isnrrqnvenov CI'lYOFEVERETT rumir,wonns — <br /> +— <br /> � � r LOCAL SALES �— <br /> oatE � �/ Kj TAX CODE IS 3105 T07AL � _ <br /> U�_ <br />