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�- _. <br /> APPLICA'TI�,�1 FOR COI�iSTRUC7 �aN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 9gp01 •259-8810 TT <br /> fl GEMOUTION fl COM�INATION fl BUILDING �l MECHANICAL r� pLUM81NG fl SIGN <br /> PRC�JECTADDRESS ��2 � //��A � � � ���` �� <br /> .�LJ I� <br /> OWNE� � MaILA�OAE�� ��glry 2IP PHONE \ <br /> � / � �3'Oz ` <br /> �N�NT MMLADOR�I��O �� ��WAiY ZIP ,yp.•• "__"_ _- - <br /> � �.v� S�zoy sr -o� <br /> ARCHITCCTOROESIGNER MAILA�ORE55 �ItY )IP pHCNE <br />� GENERALCONiMCiOP MMLA�ORESS CIiY ZIP p110Nf: SiqTELIGENSE� <br /> MECH�MCALCONTR4CTOR MAILADORE55 fITY 21P PIIONE STATELICFNSE• <br /> PLIIMBINGCONiRAROR MNLADOPE55 Cltt ZIP PHL:IE STAIEIICENSE� <br /> CONiRhCT PAICE OF WOfiK -- <br /> HEATING SYSTEM: i l GAS �1 ELECTRIC f 1 <br /> OESCFIBE WORN ANO SOVARE FOOT�GE INVOIVED CONTACT PEHSON AND PIIONE NO. <br /> n <br /> �- i � r �� � ; ,� <br /> � HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TFIIS <br /> . PPOPOSFD USE OF BUILOING ,� \ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> s'��I�.b� SH.'C/LJ PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � WORK WILL bE COMPLIED WITH WHETfiER SPECIFIED HEREIN OR <br /> LLGALDESCRIPTIONOFPROPERTY�SHOWN9ELOWORATTAGHTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GNE <br /> � ��r s�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> _ PERFORMANCE OF C STRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PR P Y T PERFORM THE WORK FOR WHICH <br /> APPLICAT S AD ND I COMPLY WITH THE STATE <br /> anRCEI n�l 1 D.NUMBER CONT T L 182 W A D 296200 WAC. <br /> ��/ - ' - 2 - � <br /> CONSTRUCTIONLOANLEN�ER.ADDRESS.TELEPNONE NUMBER --�•� <br /> SIGNATURE O�TE <br /> CIiV 6USWE55 LICENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEe <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNRS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) HEAT PUMP , <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEIJ SINK 8 DISP i CLOTHES DRVERS ' <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER WATER HEATER , <br /> URINAL WOOD STOVE � <br /> DRINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) ; <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE —r <br /> ; GAS PIPING � <br /> � <br /> i EXHAUST FAN ' <br /> � , <br /> SUB TOTAL $ SUB TOTAL S ; <br /> PERMIT S PERMIT S i <br /> TOTAL FEE S � TOTAi.FEE 5 � <br /> FOR OFFICE USE ONLY: <br /> PRONTSFT�CK T REAqiFTpACK � SIpESETP�K � Pl�NC11ECKNUfdfiffl FEF RECEIPTNO. <br /> usezoNFL��,,2_ iornnE7J� va��i � FEES VALUATION FEE <br /> /� J i i vEs r� No nunniNc ��� ' <br /> � Q , � <br /> HEIGIIT�tATIQN ) NOOFUWELIING SIZEOFBI�GRI � <br /> �J / UNII$ p�pM01NG <br /> OCCUPAHCV NO 0[SIOFiK OCCUPANiLOpU [1ASEMENI � I <br /> GPOUP r II _ MECNANIGAL � <br /> ll fIVES I1 NO � <br /> FIRE ALAPM qE0'l1 RFi��S�� nOCI110NN.PLAN CNF.GK — i <br /> 1 <br /> � T— <br /> OTHFR <br /> fIRF.SPtiINN1[RRF (�L Rf _ i <br /> 0 <br /> srnie nunoi�+c sunc��nncr I�L: . <br /> rvaEorr,or�sr vinNsnvrnoveonv CITYOFEVERETC �nnncwonKs <br /> LOCALSALES — ------ <br /> onTE TAX CODE IS 3105 TOTn� _ __ 2 2�_� ���t <br />