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'�" i �� �. � <br />APPLICATI�e+I FOR i'.ONSTRUCT rdN PE�MIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />f 1 DEMOLITION fl COMBINATION f�BUILDING f�MECHANICAL <<YPLUMBING f 1 SIGN <br />IPROJECT ADDRESS , , _ _, _ -�¢-1, � ,� <br />nma nooness <br />�' `�' �l lJ:1il �`�c <br />cm zir ,/ r��o�e <br />� G� r^��.' ��,Ct� ���%'n.w�-i' r%Sxri3 �' S'�' "/ <br />r.iTv zir ���aNe <br />ARCNRF.CTCRDESIGNGR MAILA��RESS � CIiY ]IP �'��ON[ <br />Gf.NEf1pLCONiMCi09 MFILAD�PESS QTY ZIP PHUY[ /f SitdELICENSF.v �/ <br />S.*'71'�.(' Cr✓ 4�hG� „I��IJl� J��. GJ$�(1 _2— <br />MECHANICAI CCNTR�CTOR IdPIL �OURESS CITV 71P PIIONE . TATF. tICENSE � - <br />PLUMBINGCONTRAf,TOR MAIL�D�RE55 CIiY ZIP PHONE STA7ELICENSE+ <br />DESCPIBE WORN AND SOUnRE FOOTAGE :NVOLVED <br />M,.. _ I . . <br />—���.� 1."1 a 3" <br />PR�i/ ,�:��� 5� S <br />D USE OF UIIDING <br />LEGAL OESGRIPTIO OF PR9 ERtt (SH( <br />LOT � BLOCK _ <br />7ARCEL <br />CONSTRUCTION lOAN LENDER. ADORESS. TEIEPNONE NUMOER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />_ WATER CLOSET (TOILET) <br />LAVATORY <br />KITCHEN SINK 8 �ISP <br />DISHWASHER <br />LHUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTE <br />SINK (SERVICE — BAR. <br />FOR OFFICE USE ONLY: <br />fROHTSETPhGK PEM SFTOACK <br />US[ ZONE �� r <br />� +� (l.I <br />IIEIGIIT //LI��MITATIONf <br />OCCUPANC� O�I <br />FIRE <br />�'/� <br />Two wriesi <br />SUB TOTAI 5 <br />PERMIT S <br />TOTAL FEe S <br />HEA'iING SYSTEM: IjJ'GAS f 1 ELECTRIC f� <br />GONTAGT PERSON nNU PMONE NO <br />A 1 -�i�l1��i%C_- �•53-13�9 <br />I HENEBY CFRTIFY THAT I HAVE HEAD AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT ALL <br />PROVISIONS OF LAWS P.ND ORDINANCES GOVERNING THIS TYPE OF <br />WOfiK N'ILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN CR <br />NOT. THE GRANTING OF A PERMIT DOES NUT PRESUME TO Gll E <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF l,NY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOFIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AM1D I COMPLY WITH THE STATE <br />CONTHACTORS LAW 1827 RCW AND 296.200 WAC. <br />/I � <br />x � tX��,.�-.�, g- 9- 9 5� <br />SIGNATURE —T �ATE <br />CIiY DUSME55 LICENSE NO <br />� MECHANICAL <br />FEE NO. TYPEOPEQUIPMENT FEE <br />0 <br />SIDESETBnCN ��I�N <br />A/C — A/HNDLG UNITS — H.P. <br />FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES ORYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER, <br />WOOD STOVE <br />METAL FIREPLACE i <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPI!JG <br />EXHAUST FAN <br />IOiAREA VACANISIT[ rcw _ <br />— i IYES f 1 YO pUILDINp <br />NOOFUWELLING SIZEOFOIUGRI. <br />UMB ✓ ,5F L�V�l.1%'� pLUN[iMG <br />�a�sF GA�'A��� <br />OCCUPANTlOAD BOSEMENi � � M[CIInJICnI <br />� �� IIVES -VNO <br />AflDi' IONAL PI AN C��[CN <br />RF�SON <br />o��+Er. <br />RFASON <br />srme ouiton+c sunc��nnce <br />vinNsnrrnovnqv CITYOFEVERETT rumir.wonKs <br />j_y LOCAL SALES -- <br />unre c3 Zb/95 TAX CODE IS 3105 TOTAL _ <br />—�— <br />SUB TOTAL 5 i <br />PERMIT 5 � <br />TOTAL FEE S ' <br />pE[ nFCFlrt No <br />VALUATION FEET_ <br />% l �o oZ % � � �JC� <br />i � /� <br />� <br />