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APPLICATII.nI FOR CONSTRUC7 rON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />11 DEMOUTION fl COMBINATION fl BUILDING fl MECHANICAL �� PL1IMBING f 1 SIGN <br />PROJECT ADDRESS / 3 r7./.�. n� ,) � <br />lOa �. r � pt� <br />OWNEP MaILAO�RES9 ci zir mror+e <br />��Aio�►-.�.hv�k ;�c7/7- 36�a..F�(,,� ,�,,.,,,-1J 9yz%.� � S�.-/3n % <br />MAILApORF.55 f.ITY �IP PMONE <br />ARCHITEGT OR pESIGNER MAII. AD�RE55 CIry ?IP PIIONF <br />GENERAL CONiO�GTOR AIAILAO�RE55 CIIY IIP PIIONE $fATF LICENSE � <br />� .. � � 1 <br />MnIL A��PESS <br />UAIL AD�FE55 <br />GITV <br />[N1�5 <br />CONTRAGT PqICE OF WORK <br />OESCRIBE WORN AN� SOUnRE FOOTAGE INVOL�'ED <br />� � <br />� � � <br />PROPOSED USE OF BUILOING <br />LECAL UESCRIPiION Of PRpPER1Y �SHOWN BE�OW OR ATfACH T\YO COPIE$) <br />i <br />L07 � BLOCK OF � � <br />l 7 � C.-...,,E� Cc/ , <br />PARCELTA%I.O.NUMBER <br />CONST(iUCTION LOnN LENDER. P�ORESS. TELEPNONE NUMBEfl <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />'[� WATER CLOSET (TOILET) <br />BATHTUB <br />7� LAVATORY (WASH BASIN) <br />SHOWER <br />I KITCHEN SINK 8 DISP <br />( DISHWASHER <br />LAUNDRYTRAY <br />( CLOTHES WASHE <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR D(iAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL S <br />PERMIT 5 <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />fRONTSFifl F.AfISFT <br />� �� Of <br />USE20NF '� /�,/11(� IOTARE� <br />�� � v,v <br />'t— <br />IIEIGIIT LIMITPTION �!O OF DWELIING <br />ur:rts <br />OCCUPANCY NO 0� S�. �i[5 OCCUPANT lOAO <br />ALARAI <br />r�co 0 <br />�� <br />-/J <br />FEE <br />l iGENgE � <br />PHONE STATE LICENSE • <br />FiEATING SYSTEM: f I GAS �l ELECTRIC f l <br />WNiA;T PERSON FND PHONE NO <br />I HEREBY CEkTIrY THAT I HAVE RE�1D AND EXAMINED THIS <br />APPLICATION AND rCNOW THE SAME TO BE TRUE AND CORHECT ALL <br />PROVISIONS OF LP.WS AND ORDINANCES GOVEFNING THIS TYPE OF <br />WC3K WILL BE WIdPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTIIJG OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATWG CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM TI1E WORK FOR WHICH <br />APPLICATI�N IS MADE AND I COMPLY WITH THE STATE <br />CONTRACI JRS LAW 827 RCVJ AND 296.200 WAC. <br />x �', -.����% "'—�.L <br />SIGNATURE D4iF <br />CITY �USINE55 LICENSE NO <br />MECHANICAL <br />N0. TYPE OF EqUIPMENT FEE <br />A/C—AMNDLGUNITS—H.P. --� <br />) FORCED AIR SYSTEMS — B.T.U. M E.A. �! — <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M � <br />CLOTHES DRYEFiS ; <br />VENTILATION FAN � <br />� RANGEHOOD � <br />WATER HEATER <br />WOODSTOVE <br />METALFIREPLACE(WOOD'3URNING) � <br />FIREPLACE INSERT (WOOD BURNING) � <br />GAS FIREPLACE ' <br />GAS RANGE � <br />� GAS PIPING � <br />EXHAUSTFAN , <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTAL FEE 5 <br />i'l4NC�IEC�Nl1Af1FR /� I PF� � _r I RECFIPiNO <br />�,� <br />vacnrn sire " FEES " <br />��YES lNO <br />ouunmr. <br />52E OF BLOf,'TI - <br />1�8.J SP �-�•i�uCv t �wn+oivc <br />5�/�GE _ <br />[i�SEMENi <br />� � MF.CIIANICAL <br />IIYES L/HD <br />M1ODIIIONAL PL�N G�F.CK <br />on�en <br />srme nunoi�vt; sunc�mnae <br />CITY OF EVERETT rimuc wonKs <br />LOCAL SALES <br />� TAX CODE IS 3105 707AL <br />-- .�U ; c�C> <br />/�7'� �- i SI� <br />