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APPLICA,410W FAi� CONSTFEU�'�'IQN P�R11A1'4' <br /> CITY OF EVEREIT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ f:OMBINATIOPJ , „j�,BUIL.DING � MECHANICAL '�'PLUMBING L� SIGN <br /> PROJECT ADDRE— SS� <br /> �� <br /> S��Jy /l L �/� -� � <br /> 0\vl ER r MAILM�CRESS CITY ilP PMONE <br /> /��/'/// �v <br /> TENANT ` MAILApDRESS CIN ZIP PHONE <br /> aRCd1TECTCRDESiGNi�P MA;CADGpE55 ' LIIY ZIP PHONE <br /> GENE9ALC7N'iflACTOR MNLADUflESS CIN ZIP PMONE STATELJCENSE� <br /> �1�EiV BA/LTIAGJ CD/✓ST. 3rJl/-/Z2t�G,�S;E, E�eR�n- 98zos 337fia7y �!"EJl�B�2/2SR <br /> IdECHANIC�LLCONTRACTOR MNLADORE55 CITY ZIP PHONE SThTELICENSEI <br /> PLUM31N0 CONTRACi9fl� M�ICADDRESS '' CITY ZIP PNONE STATE UCENSE� <br /> W K L UCT FPICE OF WORN --- <br /> Hf_'ATING SYSTEM: �"GAS ❑ ELECTRIC ❑_. <br /> :>f SCRII IE WO.IK ANL`SOUARE FOOTAOE INVQLVED CJNTACT PERSON AND PHONE NO. <br /> �VE BflRT4o cN — 337— 907 9 <br /> I HEREBY CEFTIFY THAT I I1AVE READ AND EXAMINED THIS <br /> PROFOSED USEOFBUILDINi `�pM ATPLICATION AND KNOW THE SAMEITO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORD�NA�JCES GOVERNING TI-IIS TYPE OF <br /> � '�� WORK WiI.L BE COMPLIED WITH NHETHER SPECIFIED HEREIN OR <br /> LEGALDESC�RIPTIONOFPFtOPERTY(SHOWNBELOW ATUCHN'OfrOpIES� �S qUTHORITYTOTVOLATHAOR CANCELETHE PROVSI�ON OF AINY <br /> ii i <br /> �or �� BLOCK_ O 6 LG <br /> OTHER STATE Ofl LOCAL LAW REGULATING CONSTRUCT�ON OR THE <br /> ' � PERFORMANCE OF CONSTRUCTION.THAT I AM AU'HORIZED BY THE <br /> OWNER OF THIS PROPEFfY 70 PERF09M THE WORK FOR WHICH <br /> APPI:CATION Ifi MADE AND I COMPLY WITH THE STATE <br /> PAqCELTAX I.D.YUMBER CONTqqCTORS L�W 1827 RCW AND 296.200 WAC. <br /> COI��TRUGTiJNLOAN/�^a,nn�.���HEEHAN-75�S+5"933 SIIiNAIURE DAE <br /> L, �, x� <br /> —' / //-9s' <br /> CITY BUSINL55 UCENSE N0. <br /> PLUM91N0 MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OP FIXTURE OR ITEM FEE <br /> 3 WATER CLOSET(f01LE� � A/C—NFiNDLG UNITS—H.P. � <br /> BATHTUB ; 0 FORCEDAIRSYSTEMS—B.T.U. M E.A. ; <br /> ,3 LAVATOPY(WASH HASIN) � HEAT PUMP � � <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> / KITCHEN SINK&DISP i CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATIqN FAN � <br /> LAUNDRYTRAY ; RANGEHOOD ' <br /> /- � � CLOTHES WASHER -- � i WATER HEATER T— <br /> � URINAL ' � W00�STOVE � <br /> � �� ".DRINKINO EOUNTAiN��� � i METAL FIREPLACE(WOOD BURNING) ; <br /> �FLOOH DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; . GAS FIREPLACE ; <br /> SINK{SERVICE--BAFS�,ETC.) � GAS RANGE —T <br /> ' '�, GAS PIPING - ' <br /> � � EXHAUST FAN I <br /> i � <br /> � i <br /> i i <br /> SUB TOTAL $ ; SUB TOTAL S ' <br /> � PERMIT $ � PERMIT S � <br /> TOTAL FEE S � TOTAI.FEE S � <br /> FOR OFPICE USE ONLY: <br /> FRONT SETBA�K J J REM 6ETBALg� J 6�DE SETBACN� � PUN CHECR N�B�E v FEE RECEIPT NO. <br /> S l ��(I _] <br /> �USEZON .'.' ' LpTAREA . VACrWT51TE FEES VALUATION FEE <br /> _�L'� . O OVES ONO BUIIDIN� 5 ;—�. ) i , <br /> i : <br /> HGIGMTUMITATION ' ' - NO.OFDWEWNO SIZEOF6LD�/LI. n i / <br /> UNIT9 ' I(p� S FS I,IG.-�(a •{— PLUMBIN6 '� ip�.1 <br /> OCCUPANCV NO.OFSTOPIFS OCCUPANTLpAU BASEMENT ME:HANICAL ��� t I ��il <br /> GRO P <br /> � ��� � �-�-'� � � OYES NO i <br /> FIpEAUHMpEQD�r _ p�,5pry . ADDITIONALPVJlCHECK i <br /> i <br /> , �'u �, � ..- � OTNER �; ) i i;.�. <br /> FIRESPWYKLERREO'0 �� qFApy � ' <br /> � � �� ^ STATEBUIIDINOSURCHARGE <br /> _:/�: _ ) <br /> TVPE OF�ONSL , PUNS NPROVED BY � , <br /> CITY OF EVEREI"f vueuc wowcs � � <br /> �.N, �J 1�' LOCAL SALES , ; <br /> o�re Z/'7 is TAX CODE IS 3105 TOTAL J,� . . ; ; ') <br />