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APPLIGAiIOnI �O�i CONSTRUCT�ON PERM1�' <br />� CIl'Y OF EVERETT • BUILDING DIVISION <br />"-%`'�'- �; .-��-�' I j2 i 3200 CEDAR STREEl" • EVERETi, WA 98201 • 259-8810 <br />fl DEMOLITION fl COMBINATION �l BUILDING I-1 MECHANICAL � 1 pLUMBING f l SIGiJ <br />PROJECT ADDRESS � <br />//l / % % 7 �' r' �� /,c � <br />OWNF�1 MAILAUDRESS �RY ZIP PMONE <br />_% G/� I I� {� - Sc-�1 �; c.�"� ,�0 7/ %- � 6 Y=i c:.-c ��'C. .aG�-. ...,i c• n i,S'c;z � s�-/3c S <br />TENANT � MMl AODRF.55 CITV ZIP PIIONE ' <br />ARCHITFCTOROESIGNER MAII.AppRE55 CITY )IP PHON[ <br />GENEftALCONTfiACTOR MnILADURE°� Cllv ZIP Pr10NG SiAT[lIC[NSE� <br />C_. i r-. <br />rno�nnrvi�n�curviMncror+ Mnllno�RE55 CIN 71P PIIONE J ST�T[IICENSE� � <br />PLUMBING CO47RACTOR MAILADDRE55 CITV 21? PHONE STATE I.ICENSE � <br />DESCFIBE WORK PNO SOUAFlE FOOTAGE INVOLVED <br />OF BUILOING <br />LOT I � BLOCK _ <br />/ 1 2 ''`�� 4� - .� �-'� <br />. ���/�9 <br />CONSTRUCTIONlOANLENOER.�D�RESS,TEIEPMONE YUMBER <br />NO. � TYPE OF FIXTURE OR <br />� WATEH CLOSET (TOILETI <br />LAVATORY <br />j KITCF'cN SINK 8 DISP <br />� DISH�NASHER <br />LAUNJRY TRAV <br />J CLOTh1ES �VASHEF <br />URINAI. <br />DRINi ,VG FOUNTAIN <br />FLOOR DI ��IN <br />BACKFLOW PREVENTE <br />SINK (SERV�(;t — BAR, <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />FOR OFFICE USE ONLY: <br />fBONT SETPALN FEAq SEi�ACK <br />— / <br />USE ZONE� <br />HEIGHT LIMITATION <br />Z�� <br />OCCUPFNCY NO Ot SIORiES <br />LOIAREA <br />� <br />NO OpDWf.LUNG <br />UNIiS 1 <br />�i <br />OCCUPANTIO,AD <br />N � <br />RFASON <br />RF4SON <br />P! hN5 APPROy � <br />� <br />❑tirF 12 /24 <br />nvo coriEs) <br />FEE <br />5 <br />HEATING SYSTEM: fil GAS f 1 EIECTRIC i 1 <br />CONTACT PEFSON �ND PNONE NO <br />�� �1 i �' N - l..�t- -� G 4 (• �1 .-� - � ' `� <br />I HEREBY' CERTIFY THAT I HAVE READ AND EXAMINED TNIS <br />APPIICATiJN AND KNOW THE SAME TO BE TRUE AND CORRECT. All <br />PROVISIONS OF IAWS AND ORDINANCES GOVERNING 7HIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREiN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTfiUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATIOP! IS MADE AtJD I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />� ' 9 <br />1�'J /� l , / r, �i <br />x /�✓J:� ��� ue�-i � .y+. �J � � <br />SIGNATURfi � pATE <br />CITY BUSMESS LICENSE Nn. <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />NC — A/HNDLG UNITS — H.P. <br />I FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />1 CLOTHES DRYERS <br />VENTILAI'�ON FAN <br />RANGE HOC�D <br />WATER HEAT�:R <br />WOODSTOVF <br />METAL FI�cPLACE (WOOD BURNING) <br />FIREPLACE INSERT (WOOD �URNING) <br />� GASFNEPLACE <br />GAS RF.NGE <br />GAS P;PING <br />� E%HAUSTFAN <br />$IOESETPaCH P�ANCIIECKNUMOGR <br />5' �033/ <br />VACANI SItF. FEES <br />[J�ES ! I NO <br />owiniNc <br />)F BLUGr�I <br />�.� Sp Civ..J4 + riuMuwc <br />Sf G�RAGc <br />BASEMENi � MECIInNICaL <br />(IlES Na0 <br />AODI IIONAL Pl AN CNf.CK <br />OTHER <br />STAIE BUII�MG SUnC�1nqG[ <br />CITY OF EVERETT rueur,wonKs <br />LOCALSALES — <br />TA% CODE IS 3105 TOTAL <br />SUB TOTAL S _� <br />PEPMIT S <br />TOTALFEE S <br />�EF` .� �ECEIPTNO <br />VALUATION FEE <br />