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�-� ���s �ON�'��C�J�`�a�N ��;�t�,i�r( �. <br />CITY OF EVERETT • BUILDING DIVISION MCA/0� <br />3200 CEDAR STFEET • EVERETT, WA 98201 • 259•BB70 � <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTADDRESS:_ S'`liy g� P1, S l'- �$ zor <br />D�fn MAILADDRE55 CITY <br />1��' PIIONE <br />��1.,, r��„�<,Iz s�„ti q� ��. s e. e�P,��tt �s.z:,s ssa-���o <br />TENANT '� 41AIL��ORE55 f.I1Y IIP PRONE <br />A1ICMITECT OR OESIGNER M�II AODOESS �IIY IIP PMONF <br />GENEMLCONLMCTOR MAllA00RE55 �IIY IIP PIIONF. SIAIEUCCNSE� <br />MECHANICALCONTRACTOR MAILADDRE55 n f.IfV 214' P110HC STATELiCENSE� <br />L:✓RfM1�'ian .�f�'��-Q ��w� f�`�� �J�1 ISJ:S_ L✓PrP/1� `I`62o�._.'Zi2•311N e+�e�;�.;s-s�iz�k� <br />PLUM NGCONTRACTOR MnILADDRF.SS I;IfY 11P p110NF: SUfELICENSE� <br />GONTMbT PRICE OF WORK <br />������Q <br />OESCRIBE WORK AN� SOU�RE FOOTAGE INVOLVED <br />L I N<�/:` �i CnS C�cnC l n..�� <br />, <br />PROPOSEDUSEOf /q'UILDINGy, <br />i \-0S. �t P �� « <br />LEGAL OESCRIPTION OF pROPERTV �SHOwN BELOW ql �TTACN 1 WO i <br />LOT BLOCN OF <br />PARCELTA%I.D.NUMBER <br />CONSTRUCTION LOAN LEN�ER. ADDRE55. TELEPf10NE NlIM0Ef1 <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />KITCHEN SINK & DISP <br />LAUNDRYTRAY <br />URINAL <br />DRINKING FOt <br />FLOOR DRAIN <br />SINK ISERVICE — <br />FEE <br />SUB TOTAL $ <br />PERMIT 5 <br />TOTALFEE $ <br />rOR OFFICE USE ONLY: <br />iRONT SETOACK REM SF.TBACK <br />usE zor+e <br />IIEIGIIi LIMI7ATION <br />OCCUPANCY Iq pf $ <br />GIIOUP <br />FIRE SPRINKLER REO'0 <br />LOT�PEA <br />NO OF �WELLING <br />uNrts <br />0 <br />SIfIE SElO�CN <br />VAC�NI SIIC <br />❑YES ❑ NO <br />sucornurni <br />❑YES ❑ NO <br />HEA7ING SYSTEM: �GAS ❑ EIECTRIC ❑ <br />CONUCi P[f1SON ANp PNUNF NO <br />)o¢- �'kre,��. T�. <br />� sz_ 3 � I H <br />I HEREBY CEfiTIFY THAT I HAVE READ AND EXAMIN:D THIS <br />APPLICATION AND KNOW THE SAME TO BE TRt1E AND CORRECT ALL <br />PROVIS�ONS OF LAWS AND ORDINANCES GOVERNING THIS TVPC- OF <br />WORK WILL BE COMPLIF.D WITIi WHETHER SPECIFIEO HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTI10flITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRI �CTION THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TC PERFORM TIiE WORK FOfl WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RC'N AND 296.200 WAC. <br />x '1 � " �.EL� .S --�^ - «I % — <br />SIGNA7 DATE <br />CITY BUSINESS ll(;&NSE NO <br />MECHANICAL <br />NO. TYPE OP EOUIPMENT FEE <br />A/C — A/FiNDLG UNRS � <br />� FORCED AIR SYSTEMS ; <br />HEAT PUMP � <br />UNIT HEATERS � <br />CLOTHES DRYERS ; <br />RANGEHOOD � <br />WOODSTOVE <br />METAL FIREPL <br />FIREPLACE IN� <br />GAS FIREPLA( <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />SUO TOTAL $ �IJ ' <br />PERMIT $ / � <br />TOTALFEE E I /ot ! <br />PIANCIIGCNNILMpPR IffF If1ECFIPINO <br />L���/ � <br />OI11Lf11NG <br />riuunwc <br />MFCIIANICAI <br />aoDI1lONA1. Pl nN C�If LK <br />0111E0 <br />SIA7G Ot1Ilf1ING S11(iCllnfiCE <br />CITY OF EVERETT runnr, wonKs <br />LOCALSALES ---------�- - --- <br />— -- <br />TAX CODE IS 9105 TOin� _ _ <br />. ., _..,..»....,__. _.....-'---............_....+:..:. .. <br />':[LL� <br />