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APPLICATIG.� FOR CONSTRUCT.JN PERMIT <br /> CITY OF EVERETT•EiUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> i-1 DEMOUTION �l COMBINATION f-I BUILDING rl MECHANICAL � ' LUMBING f l SIGN <br /> PROJECTADDRESS G �^ �- �./ <br /> 1 li�.J`t'. Z,✓•�P�1 <br /> OWNER MnILADDRE55 GItY ZIP CNONC <br /> �i,� r,A-�,i ,D �? �. �U�- sdc� �.e,a�Wu ���o,�-�a �� a �� - �r?n� <br /> �ENIINT // ` /�IAqllqpqJ((�E55�j fliV IP PNONE <br /> �J aL/'L� l'��P�C,tI"L idy.Q.�..J�. 4� _ . <br /> PAGNITCCTOA�ESIGNEf1 MAII n0�RE55 qLY ]IP PHONf <br /> GENERPLCONTRnLtOq MnILRWRE55 �Itt pIP FIIONG gipTEUC[NSE� <br /> MECNANILAL CONTR�CTOA MMl A�DPE55 CIiV ZIP PNONE STFTE LICENSE� <br /> Pl MBI CO f.TOH II�DDRE55 GiY zlP P110NE STr1TEUGENSE� <br /> � ` c�,c /J 2� CLv-P. .T w � 9d -v f�277'P+ld? <br /> cor+ra,.ct vnicE or wonK <br /> HEATING SYSTEM: I l GAS �l ELECTRIC f l <br /> . DESCRIBE WORK ANO SOVARE POOT�GE INVOLVED CONT�CT n[PSON�ND t'NON[N0. <br /> 1 HEREBY CERTIFV THAT I HAVE READ AND E%AMINEU THIS <br /> PROPOSEDUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC7 ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � LEGALDESCRIPTIONOFPqOPERiV(SHOWNBELOWORATfAGHTWOCOPIES� NOL THE GRANTING OF A PERMIT DOES NOT PRESUME 70 GNE <br /> �or eiocK or AUTHORI7V TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHEFl STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTNORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOflK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITN THE STATE <br /> P�RCEI TN(I.D.NIIMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> GONSTRVCiION tOAN LEN�EN.�UDPESS,TELEPHONE NVMBER Z ���� l I� �� y) <br /> SIGNRTUR-E� OATL <br /> LITY BUSING55 LICENSC NO <br /> PIUMBIN6 MECNANICAL <br /> NO. TVPE OF FlXTURE OR I7EM FEE NO. TYPE OF EGUIPMENT FEE <br /> WATERCLOSET(TOI:ET) � A/C—AMNDLGUNITS—H.P. � <br /> . BATHTUB ; FORCED AIR SYSTEMS—B.iU. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> � KITCHEN SINK 8 DISP i CIOTHES ORVERS i <br /> DISHWASHER � VENTILATION FAN i <br /> LAUNDRV TRAY ; pANGE HOOD ' ' <br /> CLQTHES WASHER � WATER HEATER � <br /> UF�NAL � WOOD STOVE ; <br /> �RINKING FOUNTAIN i METAL FIREPLAC[(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD DURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERVICE—DAR,ETC.) � .9 GAS RANGE � <br /> ( �.�,.,iF GAS PIPING � <br /> � EXHAUSTFAN � <br /> i � <br /> o� 4 i � <br /> SUB TOTAL S SUB TOTAL $ �� ._ <br /> � PERMIT $ " ) � PERMIT $ � <br /> TOTALFEE $ � � TOTALFEE S � � <br /> FOR OFFICE USE ONLY: <br /> �RONTSETPACK REAfiSETBACN SIDESETBACK PUNLNECRNUMOGR �GE RfCFIPTNO. <br /> `� � �J`) / <br /> uSeZONe ioraneq wCnNrsirF FEES VALUATION FEE <br /> I lYES �' N� BUtLDINC � <br /> - i <br /> NEIGHTUMIiAT10N NOOFDWCLLING SILEOPALDGRI <br /> UNiiG {+�UMBING <br /> GOUPANCV M�OfStORiES fKCUPANiL04D BASEMENT MECIIANICAL � <br /> ♦ <br /> f1YE5 il NO - <br /> FlREAIAfiMREOD �fASDY ADD1110NALf'lANG1F.GK <br /> �-- <br /> O1HER � <br /> FIRFS�RINKIERRF.OD RFRSpN � <br /> SiAIE OIIILDM6 SURLI/FAGE <br /> i <br /> iYt'EOFf,ONSi PI�NSAPPfiOVE�BY CITYOFEVERETT �ueiicwonKs <br /> LOCAL SALES --- <br /> ��rE TAX CODE IS 3105 TOTAL 3 C � <br />