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� (1N� �� 7 ��� <br />APPLICATIOrI FOR CONSTRUCT�JN PERMIT <br />CITY OF EVERETT • BUILDING DIVI,riION <br />32or C EDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION P�1 COMBINATION I�BUILQING F�I�MECHANICAL fq'PLUMBING (l SIGN <br />PROJECT ADDRESS <br />�nA�.-, �-, f-'l� ,. � <br />� cnY 21P P110NE <br />I�- a���-I s� 1, �� � t; ���� � 3�-�� ��/�i s� �.�,- � c�� ��a�� �sa-���� <br />TENANT MNLApURF55 GITY ZI� <br />PHONE <br />ARCHITFCiO�l0E51GNEfi MFILqDORE55 CITV 71P PHONF. <br />���RES$ �ItY Zln p��ONB Si�TE LICFNSE • <br />� ^ <br />-��"T-'"L" . lr. SCl7]LO O�J fi� �. n r/'. I_ �) c _ <br />•�•• rnv++e � STATE LICENSE � Q <br />PLUM9INGCC4iRnf,TOP MAILAODRESS CIiY ZIP PHONE <br />STAiE LICENSE � <br />wrviNnGi PRIGE OF WORN <br />DESCRIUF WOPK AND SOUrIRE FOOTAGE INVOLVEO <br />7?«,.,-- . �,,,-�,�� <br />PROPO EU USE OF BOILUiYG <br />� ! x.�l� �i�i � <br />LEGAl0E5C 110NOF OPERTV�SNO BELO ORATTAGHTWO <br />LOT f BLOCK pF � / `a �' � <br />7iJ�✓�_M N�r„�rit,� .�C <br />PARCEL TA% I.D. NUTABER <br />CONSiRUCT10NlOpNLENOER,qDURESS,TELEPMONE NUM9ER <br />PLUMBING <br />NO. TYPE OF FIXTUHE OR ITEM <br />WATER CLOSET(TOILET) <br />� BATHTUB <br />_ LAVATORY (WASH BASIN) <br />SHOWER <br />I KITCHEN SINK 8 DISP <br />/ DISHWAS�iER <br />LAUNDRYTRAY <br />I CLOTHE5 WASHER <br />URINAL <br />D9INKING FOUNTAIN <br />FLOOR DRAIN <br />SINK (SERVICE — <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />fRONT SFTpACN � REM 5 <br />USE ZON� <br />i� <br />MEIGHT LIMIiA110 <br />OCCUPANCY BO Of <br />IATAREA <br />NO OF DWEILWG <br />UNIiS <br />uniE <br />FEE <br />HEATING SYSTEM: N'GAS f I ELECTRIC fl <br />�ONi�� P[RSON AND PNONF. N0. <br />1� N �,ZN - S�(-� ��'� - � a`�� • l. 3 c <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMIPlED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLIED VJITH WHETHER SPEC:IFIED HEREIN OR <br />NOT. YHE GRANTING OF A PERMIT DOES NOT PRESUME T6 GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROP[R7Y TO PERFORM THE WORK FOR WHICH <br />APP�ICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />x rrI � <br />4' , • _ � /6-a -1 S` <br />SIGNATUP_ pAT� <br />CIN DUSWG55 LICENSE NO. <br />N�• I TYPE OF EpUIPMENT FEE <br />�v� — wnrvuLci uNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M E A. <br />HEAT PUMP <br />UNI7 HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VE�lTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD 57UVE <br />METAL FIREPLAC[ (WOOD BURNING) <br />FIREPLACE INSERT (WOOD BURNI��G) <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUST FAN <br />� SIC�E SETB�y�f � PI�N C11ECN NUU FR <br />� 9/ % <br />vncaNr sirF FEES <br />fiYES Ii NO <br />�winn�r, <br />SIZE OF BIOGRI <br />/Z90 SF Uvt.i4 t run�niNc <br />o� SF Gn . G.; <br />P45EMENT � M1�ECN�NICAI <br />IIYES i�Tjp <br />/+f1DI110N�L PI AN pIGCK <br />pil1EP <br />StAIE �WLOL•:G cURCN�RGE <br />CITYOFEVERETT run�ir,wonKs <br />LOCALSALES <br />; TAX CODE IS 3105 7o7pL <br />SUB TOTAL $ <br />PERMI i S � <br />TOTAL FEE 5 � <br />�— <br />FFf- Rf:f.flPrNO. <br />VALUATION FEE <br />69 /� — �—� <br />_ <br />,� � i (,.��_) <br />�oC7 i (it: <br />i� � <br />� <br />