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APPLICAT10�1 FOlR CONSiRUCT�ON PERMfT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 9tf201 • 259-8810 <br />I-1 DEMOLITION fL1�COMBINATION fA'BUILDING �MECHANICAL fL7�pLUMBING f l SIGN <br />r"ROJECT ADDr7ESS /0�� � n! � � <br />I /7r (/ <br />J <br />/ / - -3 G� � a-�.- <br />TENANT � �AAILAOORF.55 CITY 21F FnONE <br />AfiCHITEGTORDE5IGNER MAILA�DRESi CIiV ZIP PNONF. <br />MFII <br />PWMBING CO�liRACTOR <br />CONTqACT <br />UCSCFIBE WOOK AND SOUARE FOOiAGE INVOLVED <br />raoroseouseoFnuaowc �� � <br />S � � i�r //'�J� � <br />LEGAL OESCPIPTIO F PPOPEPTV ISHOWN <br />LOT � BLOCK <br />PARCELTA% <br />CONSTRUCiIONLUANLENDEP.A00RES5.TElEPHONE NUMBER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR <br />WATER CLOSET(TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />I K:TCHEN SINK 8 DISP <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTE <br />SINK ISERVICE — BAR, <br />FOR OFFICE USE ONLY: <br />FRONiSETPaCK_ y PEAR SFTBAGK <br />�� �i / <br />c__ti <br />USE <br />HEICHT <br />IOTAREA <br />CI1V 21f' PNONF <br />cin <br />c�rr <br />FEE <br />_ <br />� <br />—� <br />— ---� <br />SUB TOTAL $ ; <br />PERti'IT £ � <br />TOTALFEC S ' <br />) SIDE56f3`�K� / <br />' ^ � � <br />c1..� <br />VACP1Jf SIiE <br />J / NO.OFOWEILING <br />UNItS <br />OiSIOPIES OCCUPANTLOAD <br />�LARM RCO'D �IFntiON <br />iPRINNi[RREO'D �fAgO�J <br />pFf.ONS� �IANSAPPROVF.DOV <br />—(]' J I-�- <br />..'L '/� oaiF 2/Z Z�5 <br />GS <br />LICLNSt Y <br />1 l� �_5� <br />UCENSE� <br />STATF. UCENSF. • <br />HEATING SYSTEM: (�rGAS ( I ELECTRIC f� <br />I HEREB:' CEFiTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICAi ION AND KNOW THE SAME TO BE TRUE AND CORRECI ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TYPE OF <br />WORK WILL BE C�MPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERh11T DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIULAiE OR CANCEL THE PRUVISION OF ANY <br />OTHER STATE OR LOGAL LAW HEGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRIiCTION. THAT ! AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERT'f TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AtvC I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />X 0/��'S�f c�[�"+�c�y o� -.z /� f'% <br />SIGNA7URE � DATE <br />QiY BUSINESS LICENS[ NO <br />NO. TYPE OF EQUIPMENT � FEE <br />rv�. —n•ni��w urvi i �— n.r. <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRY[RS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREP! ACE (WOOD BURNING) <br />FIREPLACE INSERT (WOOD BURNING; <br />GAS FIREPLACE <br />G,aS RANGE <br />GAS PIPING <br />E%HAUSTFAN <br />SUB TOTAL S <br />PERMIT 5 i <br />TOTAL FEE S ! <br />PL�Ny11EC n��F- I �EE �•1 _ I RECFIPI N0. <br />iC/ <br />�lY[S ItN.. OUROWG <br />512EOfBLOG/TI L�UIiJCi 1- <br />IO��( S�F• PLUMpING <br />IB Sf GPRP4�. <br />9RSEMENi MEClInNIC4L <br />IIYES �0 <br />FODpIONM PLAN CIIF.CR <br />OiHER <br />STN [ 0� I II�ING SURCHMGE <br />CITY OF EVERETT runur,wc��cs <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />7 <br />