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v��) ���� , . . _ <br /> G b s APPLICA'T' �t� FOR CO�lSTRUC '10�1 PERMIT <br /> CITY OF EVERETT • BUII.DING DIVISION <br /> ��i 3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION f�'BUILDING ❑ MECHANICAL ❑ PWMBING ❑ SIGN <br /> PROJECTADDRESS ,��3� I �I� 1� � I? l,U �Ie� � � <br /> OWNER MAII.f.DDR[SS CITY ZIP PHONE <br /> �+��ce 1-�dMes��� 1 i�4lS ���!/-.G�lut� � s�fikll l.J�b 4go12 44�1-6�GS <br /> TENAN� MAILAOORE55 CITV l� ZIP PY.ONE <br /> AqCHITECTOR0E51GNER MFIIAD�RE55 CIIY ZIP PHONE <br /> GESIALCON�RA TORS�C MA190�v �4L' ���/• �'C'IIY �4� IP•�� 9�' �f�E ���CENSE���O <br /> _h�c�?� �s r I��I� 'K6'I�/I- �JeTC' L�'a!u ���� 4/� 9�a 12 �� ^/�(nG� <br /> MECHANICALCONTRACTOR � MAILA�DRESS CI� 7.IP PIIONE STAiEUCENSE� <br /> PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSE� <br /> � I zD d/Jn <br /> CONTFlACT PRICE�OF WORK p <br /> HEATING SYSTEM: L GAS ❑ ELECTRIC ❑ <br /> DESCRIBE W flK A �SOUARE FOOTAGE INVO VED CONTFCT PERS N ANO Ph10NE N0, <br /> � � J � <br /> i��l �,7�e� � u � C� �6 � � <br /> L � � �"o�CI' G �I � I HEREBY Ck�ilii=Y THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATIOP'�AND ICNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PPOPOSED USE OF BUIL�ING PROVISION.4 OF Lt,WS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK Wil.� BE COMPI�ED WITH WHETHER SPECIFIED HEREIN OR ' <br /> IEGAL0E5CRIPTIONOFPROPERN(SHOWNBELOWORRTTnC11TWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot n�ocK oF AUTHORITY TO VICIATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � f PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZFD BY TFIE <br /> OWNtR OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAflCELTA%1.�.NUMBER CONTRACTORS LAW 78.27 RCW AIJD 296.200 WAC. <br /> i ///��' <br /> CONS CTIONLOANLENDER.AD�flE55,TELEPHOHENUM9ER x (. L/,/��� L� �� ^ 1D-51^ J� <br /> SIGNATORE DFTE <br /> �� G/,��C� CIN BUSINES]LICENSE HO. <br /> PLUMBING MECHANICAL <br /> NO TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; � <br /> LAVATORY(WASH BASIN) i HEAT PUMP � <br /> SHOWER ' UNITHEA7ER5—B.T.U. M ' <br /> KITCHEN SINK&DISP i CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY � RANGE HOOD i <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(VJOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SWfC(SERVICE—BAR,ETC.) � GAS RANGE � <br /> � GAS PIPING ' <br /> i EXHAUST FAN � <br /> � � <br /> i � <br /> i � <br /> i � <br /> SUBTOTAL $ ; SUBTOTAL 5 ' <br /> � <br /> PERMIT S i PERMIT $ � <br /> TOTAL FEE S � TOTAL FEE 5 ' <br /> FOR OFFI:E USE ONLY: <br /> FROMSGT�ACk REARSETOACK S:�ESEiOACK PLANCHECNN �ER FEE RECEIPTNO. <br /> 7 <br /> uSezoNe LOTMEA VACANTSIIE FEES VALUATION FEE <br /> nr�s n r+o � ��r, <br /> OUIlOiNG � �✓���� S� iL':�� <br /> rJ' <br /> HEIGNT UMITATION NO.OF DWLLLING SIZ@ OP OLDGRL — i <br /> UNITS �y� PLUMEING i <br /> C/ <br /> GROUP NCY NOAGSTOflIES O�:QIPANTLOAD BASEMENT MECIIANICAL � <br /> I •� ❑YES O i <br /> FIREALARIAqEO'0 REASON ADDITIONFLPIANCMECK I <br /> ND OTNEfl � <br /> i <br /> i <br /> FIOE SPR�NK�ER REO'D R[�SON i � <br /> NU STATE OUiL01NG SVRC11qqGE L �� <br /> TYPEOFCONSL PIANS�PPROVE00V i <br /> ,� CITY OF EVERETT PUOLIC V/ORKS <br /> JM LOCAL SALES � <br /> DATE z7 G� TAX CODE IS 3105 TOTAL � . <br /> / � <br />