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APPLICATlOrI �OR COidS'�*i�iUC3'�ON PERIVIi'� <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR S7REET • EVERETT, �N,\ 98201 • 259-8810 <br />f� DEMULITION �l COMBINATION CX BUILDING I v-MECHANICAL f�=;-PLUMBING fl SIGN <br />PROJECT ADDRESS , �. ,. <br />/�'� � � ,— � .,� � � �-�� f/ � <br />! MAILAODt1E5S ��n. <br />Z ' PHONt <br />oW�� �.7= 7/ 7� 3 G%�i� a.-�o �i� �.� ��- ��- z��.I/ r;;�9� G S;� �i �(� <br />fENqNT MTILAODRE55 Y`� � / <br />'ITV �m ...,..... <br />ARCHrtECTOROESIGNER MAlI.p00fiE55 CITY eii PHONE <br />PLUMBINGCOMR;CTOR MAILAODFESS CItY ZIP VHONE 51A7LLICENSE� <br />�..urv�HqGT PRICE OF <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVEO <br />0 <br />..c�..� -uyru�rnUrtNtt��HOWNBELOWORr1RnCH7WOP <br />LOT I � _ BLOCK F ! / � '�'}�I � <br />/� �p---�- � <br />t�Zt-'ttiCB� � / ^-�-�-c• �^ <br />PAflCELTA%�.�. NU61�ER <br />CONSTRUCTION IOAN LENOER. ADDRE55. TELEPHONE NUMBER <br />PLUMBItJG <br />NO. TYPE OF FIXT <br />WATER CLOSET (TOIL <br />BATHTUB <br />'� LA�ATORY (WASH BAE <br />SHOWER <br />KITCHEN SINK 8 DISP <br />I DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK fSERVII:F — RCti FT <br />OR ITEM <br />SUB TOTAL S <br />PERMIT 5 <br />TOTALFEE S <br />FO�i OFFICE USE ONLY: <br />FRONTSF.TBACK REAfiSFiBALN <br />2�� 2�� <br />USEZONE �'� LOiAPEA/ ��� <br />C � ' <T c� <br />YEIGMT LIMCATION � NO OF DWELUNG <br />ZUNif$ <br />OCCUr'FNCV NO Of SIOIiiFS OCCUPANT LOh� <br />GROUP <br />C'-3/Je I n//iL <br />REncpq <br />�/✓ I untE <br />FEE <br />HEATtNG SYSTEM: d�l'GAS r I ELECTRIC ( l <br />�CONTA j�50 / PH [ N <br />,�._., • Z���.�a -i3� > <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORf11NANC�S GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GHANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTFIORITY TO VIOLATE OR CANCEL THE PROVI:ION OF ANY <br />OTHER STATE OR LOCAL LAW flEGULAT!NG CONSTRUCTICN OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOFIZED BY THE <br />O�JNER OF THIS PROPEHTY TO PERFORM THE WORK FOR WHICH <br />AFPLICATION IS MADE ANO I COMPLY WITH THE STATE <br />CONTP,ACTORS LAW 1827 RCW AND 2962UO INAC. <br />x_�.l�u��•� 1C1-5 -95 � <br />SIGNATUR- / OAIE <br />CITY DUSINE55 LICENSC N0. <br />MECHANICAL <br />NO. 7YPE OF EQUIPMENT FEE <br />. . ,. ........�.. ..�.� �.a — n.r. � <br />�__ <br />FORCED AIR SYSTEMS — B.T.U. M E.A. � <br />HEAT PUMP � <br />� <br />UNIT HEATERS — B.T.U. M � <br />CLCTHESDRYERS � - <br />VENTILATION FAN , <br />RANGEHOOD � <br />i <br />WATER HEATER , <br />WOOD STOVE � <br />METAL FIREPLACE (WOOD BUflNING) ; <br />FIREPLACE INSERT (WOOD BURNING) � <br />GAS FIREPLACE � <br />� <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN , <br />SIOESET�4CK P�ANp1EC ryUMdF.R <br />5 ��t � <br />VACA'N/I 51 i E FE E� <br />y�YE$ ft NO <br />nunowc <br />1F OL�G�f I <br />) SE LIVN/[j �- p����Af11NG <br />L S n,t4G� <br />BASEMENT / AtEC114NICAL <br />IIYES I�,M] <br />M1DOIII�kN. PLaN CH(CK <br />OiHER <br />STniG pWtDMG SIIRCImqGE <br />CITY OF EVERETT runi.ir, vrunKs <br />LOCAL SALES <br />TAX CODE IS 31�5 70TAL <br />SUB TOTAL F <br />PERMIT S i <br />TOTALFEE 3 � <br />FEE PBf,FIPihO. <br />VALUATION FEE <br />G � �3/ :J l� � i O <br />i <br />��'� '-�:� <br />i <br />/o O � ��_ � <br />-- � <br />— `�—_ <br />, '�/ � � . . '' <br />