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� � APPLICATI�1 FOR CONSTRUC�ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION CI COMBINATION Cl BUILDING (P7 MECHANICAL 17 PLUMBING fl SiGN <br /> PROJECT ADDRESS <br /> � 93O M AP�E �jT, <br /> OWNER MAILAODRFSS CITY 2u` PMONE <br /> C�iRwvN�,.Sn �ouPcro+�z,�& Sal wn«Ss Stnrr�E 11/9 �i%`o ) 4�{Q—�3J� <br /> TENANT MAILAODRESS CITV ZIP PHONE <br /> C�NG�E�eze.TTp,.,c a93o MraPLeSC L=�PrzetT WQ 9R�o1 <br /> PRCHITECTOqDESIGNER MAILAOORE55 CITY 21P PHONE <br /> GENERALCONRiACTOR MAILAD�RESS CITY 21P pNONE STAiELICENSE� <br /> MfE1CHANICALCONTRIICTOR MAIIADDRE55 CITV ZIP PHONG STATEUCENSE� <br /> 7'704ODAY- PAYLKS Irc Po Q�c 69ao8 SEa�1t.E VA �1$g ay�a-97� �-10U�UP1379h0 <br /> PLUMBINGCONTqACTOR MAILAODRESS CIIV ZIP PHONE STATELICENSE� <br /> CONTR�CT PRICE OF WORK <br /> � QO(J HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> �ESCRIAEWORNANDSOUAREFOOTAGEINVOLVED GONT�CTPERSONANDPHONENO. <br /> f�L-Lo� S=a�v o ' Pz Fv �YL <br /> I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF 6UILDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT.ALL <br /> �-1o5PSTAL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGA�DESCRIPTIONOFPROPERTV�SMOWNBELOWORRTTACMTWOCOPIES) NOT. THE GRANTi'�G OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> SLE ATj�O.:NED PEFFORMANCE OF CONSTRUCTION.THAT I AM AUTHOiiIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORAI THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TRX I.O.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCiION LORN LENDER.�D�RE55,TEIEPHONE NUMBER X- ,/�•(n���I�Q• 1�/9/96 <br /> SIGNATURE � ) 653 pATE <br /> GTY PUSWE55 LICENSE N0. <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OP FIXTURE OR ITEM FEE N0. TYPE OF FUCTURE OR ITEM FEE I� <br /> WATER CLOSET(TOILET) � A/C—AMNQLG UNITS—H.P. i <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. ' <br /> i <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK&DISP ; CLOTHES DRYERS ' <br /> DISHWASHER � i � <br /> VENTILAT ON FAN i <br /> LAUNDRY TRAY � RANGE HOOD � <br /> � <br /> CLOTHES WASHER i WATER HEATER � <br /> URINAL � WOOD STOVE � <br /> DRINKING FOUNTAIN ; METAL FIREPIACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) �— <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ' GAS PIPING � <br /> � EXHAUST FAN ; <br /> ' 1 Dsfw5E2 � <br /> � , <br /> � , <br /> � , <br /> SUB TOTAL S ; SUB TOTAL 5 ?,r7 ; � <br /> PERMIT S � PERMIT S - � � <br /> TOTALFEE $ � TOTALFEE $ �J� - <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBRCK REM SETOACK SI�E SETBALK PIAN CH'cCK NlIMOER FGE RECEIPT NO. <br /> � 7��C <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> IlYES f1 NO OUILOINCa � <br /> MEIGNTLI!AITATION NO.OfOWELLING SIZEOFBLDGRI. <br /> i <br /> UNIiS � <br /> PLUMBING � <br /> � <br /> OCCIIPANCY NO OFSi0RIE5 OCCUPANTLOAD BASEMENT � <br /> GROUP MECHANICA� � <br /> � <br /> I7Y[S !l NO � <br /> FIREALARMREO'D fiEA50N ADOIT10NAlPLANCHECN � <br /> i <br /> i <br /> OTNER i <br /> FIRE SPRINKLER REO'0 REASON .�_ <br /> STA7G OUILOMG Sl1RCNMGE � <br /> tvreoFcor+sr r�nnsnrrnoveoor CITYOFEVERETT runnr,wonKs —�— <br /> LOCAL SALES � <br /> onre TAX CODE IS 3105 7o7AL ; <br />