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_.� <br />APPLICA7'10�. FOR CaNSiRUCT1�N PERMIT <br />CI1Y OF EVEFIEIT � BUILDING DIVISION <br />3200 CEDAR STREET • EVEREI7, WA 98201 • 2':9-0810 <br />❑ DEMOUTION ❑ COM 1(JATION �j BUILDI G � MErHANICAL � FLUMBING ❑ SIGN <br />PROJECT ADDRESS: �y0 2 "' '!��� ' _,�. S'� <br />�i.tt�l R.ati�,r�� _ �',�t�ll,, f?�=��oi ,S� hir�:R,c;; ��s�� c,�. .2�;.ti -i i �l l <br />TENANT IAnILA0DRE55 CIIY 71P PHONE <br />i�si�r�1 �i�fi.S 19i5 n�fl��ss� ����� 9.Baos :3�:�- 05�� <br />AqC111iECT OR DESIGNER M�II A�ORE55 CIiY IIP P110hE <br />s2_u� r��c�'i ?� �x ��ca Mu�iL" �n _48z7� .35� �- a3�# �7 _ <br />CENEMIGON'MCTIXI MAIL��Of�'S f.I1Y JIP PIIONG SUTELICENSE� <br />MECHANICALCONTRRCTOR MAILADOPE55 <br />CItY 71P PuONE STREIICENSE� <br />PIUMBINGCONTRApTOR M�ILA'�OPE55 n CIIY ZIV PIIONE STA7ELICENSE� <br />t]'7 .1T..^. X� %%L� — <br />rC �c7(Z — �� C�fZ��_ -c <br />FRlWO5E0 USE OF BUILDING <br />LEGAL �ESCRIPiION pF PP(IPERTY 15110wN BElO W Of1 <br />LOT �' BLOCN Of__ <br />.�1_S11Z,�1 �DD�`I�c�� <br />- c:cc - r�ri - oc� <br />TAX I.D. <br />CONSTRUCTION IOAN LENDER. ADDRE55. iELEVHONE NlIMBER <br />� _ <br />� PLUMBING <br />NO. T'fPE OF FI%TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB / <br />L LAVATORY (WASH BASIN) � <br />SHOWER <br />/ KITCHEN SINK 8 DISP <br />DISHWASHER _ <br />LAUNDflYTRAY <br />% CLOTHES WASHER <br />UFINAL _ <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />S�NK (SERVICE — <br />FEE <br />0 <br />d <br />� � <br />i <br />_ -- ' <br />°�B TOTAL S ; <br />PERMIT $ � <br />TOTAL FEE 3 ! <br />FOR OFFICE USE ONLY: <br />FPONTSETB�CK REM SETBACK <br />n a� n x� <br />USEZONE � Y/ lO1AREA <br />�Cl <br />NEIGNT IIMITATION i HO OF DWELLING <br />' Q � UNIiS <br />riv <br />OCCUP�NCY NO Oi510N1E5 OCCUP�NILO�D <br />REASON <br />AE�S�N <br />HEATING SYSTEM: �GAS O ELECTRIC ❑ <br />cm�rncr r�nsoe� nNo ruor+e No <br />I HEHEDY CERTIFY THAT I HAVE f;EAD AND EXAMINED THIS <br />APPLICAI'ION At�D KNOW THE SAME TO BE TRUE AND CORPECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILI BE COMPLIED WITH WHETNE:i SPECIFIED HEREIN OR <br />NOT. TF�E GRANTING OF A PERMIT DO�S NOT PRESUME TO GIVE <br />AUTI�IOFlITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEfiFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORN. FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LhW iB27 RCW AND 296.200 WAC. <br />h �,�-,.y--�-Q `f ' I c� � �l `l <br />SICNn7uf1E DATE <br />CIiY f1U5WGSS LitENSE NO <br />MECtIANICAI <br />N0. TYPE OF EQUIPMENT FEE <br />SIOESE78ACN f �IAN <br />��' Sr" ` <br />vecnNr sir � <br />FOFiCED A�R SYSTEMS <br />IiEAT PUMP <br />UNIT HEATERS <br />RANGEHCJD <br />WATEF HEF,TEF <br />WOOD STOVE <br />ME�AL FIREPLACE (WOOD <br />FI�iEP1ACE INSERT (WOOC <br />GAS RANGE � � <br />GAS FIPING /// � <br />OVE$ ❑ NO OUIl0IN6 <br />SIZE OF OIOGRI <br />$�Oi o �.F rwunwc --- <br />pA EMENi Mp���qNIC4l <br />❑YES NO — <br />AU�IIIONM. PI AN CIICCN <br />ou�en <br />STn7E ��1RIlV1G SIInCllnfiGE <br />CITYOFEVERETT rumir.wanKa <br />LOCAL SALES ------- — <br />TAX CODE IS �105 ioTal <br />SUB TOTAL S ; <br />PERMIT E � <br />TOTALFEE S . <br />fEF .�?/ �ECEIPTNO <br />S/7��= ,� <br />3 <br />