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a�'� - <br />APPLICATI�.iV FOR CONSTRUC7 �OtVI PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />f i DEMOUTION �l COMBINATION �aYBU1LDING f7/AAECHANICAL tr.7-v� t�nnwwr. n cir.0 <br />r��oNE <br />ARCHRFCTOROESIGN[R MAIIADORE55 Gltt 71P PNONF <br />�iENGMLCONIR�CTOR MAILAD�RE55 GIY ZiP PIIG`!E SfATEfICFNSE� <br />5 Q.,,,, u� .,.¢...--...e �ra �vN sc o� sK� <br />MECNM1NICALCONT(i4CTOR MAllA0DRF55 Cltt 71P PIIONE . 4iF.LIC[NSE� <br />PWMBINGWtliRAf.TOR MAILAOORESS CITY 21P PHONE STAiELICENSE� <br />CONTRACT PqICE OF WORK <br />DESCFIBE WORK nN/D �S/Gl1ARE FOOTAGE INVOLVED <br />_ /(�W� l��IYLQ <br />�, o °� y . .�� .1� <br />►�-L.;,. 3'7q <br />� PROPOSEDl15E OF 9111LDING p� �e 1� L <br />/J�C f%"Ci�l <br />LEGAL UESGRIPiION OF PPOPERtt �SI WN tlELOW OR AT�i/A TWO COPIESI <br />LOT � BIOCN OF u� � <br />.� ' � �� <br />l`>/,cs�Ic. //O� <br />PAflCELTA%I.D.NUMBER <br />CONSTFUCTIONLORNIENDER,h��RE55.TElEPMONE NUMAEfi <br />PLUM8ING <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINPL <br />DAINKING F7UNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />FOR OFFICE USE ONLY: <br />FRONiSETPPCK � FF4q $FT��CN <br />USE <br />l01 MEA <br />ItlAA <br />i <br />SUB TOTA� 5 ; <br />PERMIT 5 i <br />TOTALFEE 5 � <br />SIOE SETBnCH <br />VACANi SIIE <br />IIYE$ fl RO <br />f10N f NOOFUW'LIING SIZE <br />��/ UNit$ �J <br />/ <br />NO 0� SIOniES OCCUPANT L04D <br />trFe or ro�isr <br />���� <br />HEATING SYSTEM: f/1'�,A5 �l ELECTRIC fl <br />co�irncr vr.asoN n•ro r��oNe ruo <br />- �����r` �s.�- i3� <br />I HEREBY CERTI�Y THAT I HAVE REA� 4ND EXAMI�JED THIS <br />APPLICATION AND KNOV✓ THc SAN.E TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND OFDINAKCES GOVERMNG THIS TYPE OF <br />VJORK WILL BE COMPLIED WITH WNETHER 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 />OTl1ER STATE OR LOCAL LAW REVULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. 7HAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOHM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COIIPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.'.'00 WAC. <br />� ,�� � G��..<<��, <br />�� <br />SIGNdYURE � OAiE <br />CIiY DUSINESS LICGNSE NO <br />NO. TYPE OF EOUIPMENT FEE <br />F✓C—A/HNDLG UNITS—H.P. <br />;-- <br />FOACED AI� SYSTEMS — B.T.U. M E.A. ; <br />HEAT PUMP --T <br />UNIT HEATERS — B.T.U. M <br />CLOTHES ORYERS ; <br />VENTILATION FAIJ <br />`— <br />RANGEHOOD ' <br />� 1N�TER HEATER �— <br />WOODSTOVE � <br />METAL FIREPLACE (':rOOD BURNING) <br />FIREPLACE INSERT ('J✓OOD DURNING) �_ <br />GAS FIREPLACE <br />GAS RANGE �— <br />GAS PIPINCi � <br />------ — ' <br />EXHAIiST FAN I <br />PL'.N <br />pllltplNG <br />�Q S� i.IVIIJv �- nLU1101NG <br />3 SF GACAr' _ <br />�SEMENi � � 1,�[CINNICAL <br />IIYE$ 'W.D �— <br />�DDI11pNN. PI.AN G��ECN <br />OtHER <br />STAIE OUItDING SURf,H�l:G[ <br />CITY OF EVERETT runnr.wonKs <br />LOCAI.SALES <br />TAX C6DE IS 3105 TOTAL <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE 5 <br />FFf I �FCFIPTNO <br />� ' %'iJ <br />� — <br />v ' <br />�_ --_ <br />