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�°G 3 `- <br />APPLICATIVrV FOR CONSTLR4,1C7 r0l� PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETI; WA 98201 • 259•8810 <br />�I DEMOLITION +�COMBINATIOW f'YBUILDING N�-MFCHANICAL �A�LUMBIMG I� SIGN <br />PROJEC7 ADDRESS /Og� p / J;;��/ �/ l �� <br />/ <br />OWtlE(i f� MlILAODR[5$� CiTy �{ p.� 21! PHONE <br />II,-A I i7 �•Sc.lz. c� :•Il ,2a•7/"7 • 3G •�G,%}'.(,/. i1h4„�t,._�c/ %s'.'1-92 v 5�.:"z -; 3 c, `) <br />lEP4NT MAILApDRHSS f,liV 21P PHONE <br />ARCHITFCTO�OESIGN[q MaIIA�Dq[55 CIT� ]IP PNONF <br />GENERPLGGNIR�CiOR M�IL��DRESS CIIY ZiP �IION[ SLATGIlCENSE� <br />. 5 G,�, o �� «,1-�-.�-p- 1? N I o H Sc o 5S n� <br />6�ECtiANICALCONTF,ACTOR NAIL4DI7RE55 �:fl Z6 PIIONF :4TRELI�ENSE� <br />PLUMBING COMRAGTOF <br />CONiRACT PRICE OF WOfiN <br />DESCPIpE WORN AND 5� <br />-- � <br />,;i ��:.� <br />���u� <br />PROi'OS USE OF BUILpING <br />0 <br />ior_� _ e�ocK <br />4� l.w�L•u«-= <br />PARCEL TA% I D. NU! le'eR <br />MFIL AOpPE$S <br />S <br />CONSTRUCTIONLOANIEN�ER.ADOHESS.IEIEPHONE NUTABER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR <br />'NATER CLOSET (TOILET) <br />2 BATHTUB <br />SHOWER <br />KITCHEN SINK 8 DISF' <br />DISHWASHER <br />LAUNDRYTAAY <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR UAl.IN <br />BACKFLOW PREVENTERS <br />^.WKfCFGVICF—RAR Fi <br />CI�Y <br />FEE <br />� <br />� <br />SUB TOTAL S � <br />PERMIT 5 <br />TOTALFEE 5 ; <br />FUR OFFICE USE ONLY: <br />fRONTSETPACK PFAq SFTAACN <br />USEZONE lOtAREA <br />- P�� <br />HEIGIRLIMITATION ) HOOFOWFLIING <br />� .-1 / llNlfS <br />fIRE <br />NO OP <br />CONST I n�n�i5nrvnqvE1/t�nv <br />�l l <br />SIDE SETBACN <br />ZIF PHONE STArE LICENSE • <br />HEATING SYSTEM: {+-!'GAS �l ELECiRIC Il <br />CONIACT P[qSON �NO PIIONE NJ. <br />icA1.,U.��h��,k C5a-/�o <br />I HEREE3Y CERTIFY 1-HAT I HAVE PEAD AND EXAMINED THIS <br />APPIICAiION AND KN04V THE SAti�E TO BE TPUE AND CORRECT NlL <br />1'fiOVISIONS OF LAWS AND OFlDINANCES GOVERNING THIS TYPE OF <br />WURK VVILL BE COMPLIED WITN WHETHER SPECIFIED NEREIN OR <br />NOT. TFE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOfiITY TO VICLATE OFi CANCFL THE PROVISION OF ANY <br />OTHER STFSE OR LOCA� LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. 1'HAT I AM AUTHORIZED 6Y THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPUCATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND £96.2C0 WAC. <br />X ��� � � � /� <br />.a.�-1 .iu �c�'i� fs' `}' y' S_ <br />SIGNATUFE T' OATE <br />qTY 9VSIVESS LICENS@ N0. <br />MECHANICAL <br />NO. TYPE OF E�IIIPME�:S FEE <br />A/C — A/HNDLG UNITS -- H.P. ! <br />( f�OHCED AIR SYSTEMS — B.T.U. M E.A. ; <br />hIEAT PUMP <br />l!NIT HEATERS — B.T.U. M <br />� CLOTIIES DRYERS � <br />�— <br />V�NTILATION FAN � <br />RANGEHOOD ; <br />WATER HEATER � <br />WOODS'fOVE ' <br />MFTAL FIREPLACF (WOOD BURNING) i <br />FIF:EPLACE INSERT (WOOD BURNING) � <br />� GA3 FIREFI "'� ' <br />GAS RANL. <br />EXHAUSTFAN <br />SUB TOTAL $ � <br />PERMIT S � <br />TOTAIFEE b '_ <br />PL�N CIIECN Nl1M0FR � P[F � RECEIPT NO. <br />vncnNr s�re FEES <br />i i ves r'� No eunnw� <br />x e�ocrt i <br />�,3�7 SF (.IVI/.� 4� �- PLIIMBING <br />i� s� Gn� <br />BASENENi � IAECH�NICAL <br />(lYES !L'A70 - <br />�DDII ION01. PI.AN G��F.CN <br />on�en <br />SiNE BUIIUINf, SU�CIIAqGE <br />CITY OF EVERETT �uni��wonKs <br />LOC/' l SALES - <br />TAX CODt IS 3105 TOTAL <br />/: ;-� <br />� <br />