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APPLICATI4.� FOR �ANSTRUC7 �ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />I� DEMOLITION fLI�COMBINATION f�UILDING f�l MECHANICAL H'PLUMBING f 1 SIGN <br />PROJECT ADDRESS <br />//G�/ / 7 � �� `� <br />own�en /' Mai�aoo�=_ss cm zir ri�oNe <br />J�y, ��«v�� �� 7��1- 3 4• <<� c„-c %l Cc, . �a, „�-......L wri �>�'3 iJ G S� -/ 3 0 � <br />TENAN MNLADUFE55 GTY ZIP PHONE <br />ARCHITF.CTOROESIGNEfi MAlI.A00RE55 �Itt 71P PHONE <br />PLUMBING <br />CONTRACT <br />MAIL �UDRESS <br />DESCRIBE WORK AND SOUnFE FOOTAGE INVOLVED <br />PROI'OSFD <br />IEGAL DESCRIP710N OF PROPERiY <br />�oT � e�.xK _ <br />TA% I.D. NUMBER <br />CONSiRUCTIONLOANI.ENDER,ADOPE55.TELEPNONE NUMBEP <br />TYPE OF FIkTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />SHOWER <br />KITCHEN SINK & DISP <br />LAUNDRYTRAY <br />CLOTHES WASF <br />DRINKING FOUNTAIN <br />BACKfLOW PREVENTERS <br />SINK (SERVICE — BAR. Ei <br />FOR OFFICE USE ONLY: <br />fFONT5FTP4G qEPR', <br />USEZONE� � LOTAC <br />� <br />HEIGHT LIMITATIOry <br />�� QP <br />CJ✓ <br />OCCIIPANCY NO Of 51 <br />GROUP <br />2 - � 02 <br />FIRE AL,A1RM REO D <br />IV Q <br />PIPF SPitI,NKIER REO'D <br />N� <br />7VPE OF f,ONST <br />� I / <br />/v <br />FEE <br />SUB TOTAL $ <br />PERMIT 5 <br />TOTAL FFE 5 <br />NO OF pWf.LLING <br />UNI�S <br />OCCUPAM LOAD <br />Pl nN5 APt'POVED OY <br />ONE �� /O�O <br />SIOE SETO�f.lt <br />CIiY <br />UCF.NSE• <br />HEATING SYSTEM: U%t�GAS I-1 ELECTRIC fl <br />I HEREBY CERTIF THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK 1h'ILL 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 CONSTRUCTION O(i THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOR�4 THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RC'N AND 296200 WAC. <br />A / � <br />X � . �t` . ; c- ,� - 9 5-_ <br />SIGNFTURE � OFTE <br />CITV BUSINF.55 UCENS[ NO <br />MECHANICAL <br />NO. TYPE OF EQUIPMEN7 FEE <br />A/C — A/HNDLG UNRS — H.P. � <br />FORCEJAIRSYSTEMS—B.T.U. M E.A. � <br />HEAT PUMP , <br />UNITHEATERS—B.T.U. M � <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPIACE (WOOD BURNING) <br />FIREPLACE INSERT (WOOD BURNING <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL 5 <br />PERMIT $ �� � <br />TOTAL FEE S � <br />PtM1hC11E;K�111 0�� / I f[[ I qFCFIPiNO <br />�rl� <br />vncnHr sire FEES <br />nres r Nn <br />ouanir:c <br />6 9LDG/11L <br />�3� " / J� 2� i'LIIM[i1NG <br />S�`f0 �,'�.�c <br />BASEhIENI �Ap�HnNlCnl <br />IhES Nn <br />-- ADDIIIONnI.PIANCHFCK <br />OiHEP <br />srnie ounoi�+c sunc�mnce <br />CITY OF EVERETT runi ir, vronKc <br />LOCALSALES <br />TAX CODE IS 3105 TO7AL <br />