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APPLI�CATi.rW FOR CONSTRUC �� ION PERMIT <br />CITY OF EVEFETT • BUILDING DIVISIOtJ � <br />3200 CEDAR STREET • EVEREI"f, WA 98201 • 259-0010 <br />� <br />Cl DEMOLITION O COMBINATION ❑ BUILDIN; d IyIECHANICAL O PLUMBING ❑ SIGN <br />� , <br />II <br />PROJECT ADDRESS: / � - � �I I 'i�� C� � '% r �/ I �� \' �-1 <br />1 , � � <br />..Ti... ILi I � �)�:........_""'�1�.'�7�r' � ( C r i�_'� r-'l /t 7 �. "1 .� �, ' 1 C� �- _ � 'j y _ <br />_ / <br />IEN�NI 4ML �ODf1f55 f.IIY jIP 1'110NE <br />�IICM�tCLTORDESIGHEfI M�II�Df.f1E55 qltY )i� PHONF <br />GENEiIALCONIMG/IXi Mul�0UnE55 p1Y )iP PUO�+E SfAtCtICENSF� <br />MGCNANIC�LGON7R�G10� <br />� _, w �'�E t <br />P1UTABING COHiRAf,70R <br />LONTRAGT PNCE OF W011N <br />N�R �bDf1F.55 <br />M�IL <br />Cltt <br />DESC BENOAKANDSOU REf00u EIHVOIVEq � � <br />�u= s�:�- � ���:;��_-'`�"% r'��;',�r-� <br />�i����.�-� ` U �� ,� 7�� r x ,/+��— <br />'C�rr ii.i ^�, �.- �%�/�i-.� �/��� ?� j lii.'� � iY.. <br />PROPOSEDUSE FBI�ILIENG <br />/i����PJ .- - <br />IEG�L DESCIi1PTI0N OF POOPEOTY �5110Wa BEIOW 0�1 �RAL11 M'C GOPIESI <br />�oi aiaK or <br />COHSTPULTIOM IOAN LENDER, �DOf1E55. IF.LEPNOIIE NUMPEO <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />BATHTUB <br />LPVATOFlY (WASH E <br />SF'OWER <br />KI7CHEN SINK d DI'� <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />UfiINAL <br />DFlINHING FOUNfAI <br />FLOOF DRAIN <br />BACKFLOW PREVEI <br />SINK ISERVICE — B <br />FOR OFFICE USE ONLY: <br />FRONT SEIB�LK RE�R SF.76A�It <br />USEIONE <br />NE�GIIT I�MITATION <br />OCCUP�NGY 1q C <br />G�OUP <br />FIRE SPFINKLER REf <br />SUB TOTAL S <br />PERMIT S <br />TOTAIFEE E <br />t OI �f1EA <br />NO Oi OWEILING <br />UNItS <br />OGCUPANILU�� <br />�F�SON <br />RE��ON <br />rinr�s errnoven m— <br />n•rr. <br />SIOE SE70�CM <br />}iP P110NE Si�ti tILENSF � <br />ZIP �IIONE SiAIEUGENSF' <br />HEATING SYSTEM: I�GAS O ELEC7RIC ❑ <br />f.OMUGI ri nSJNAH�1 npOuE up <br />.k�ifyP�OY CERTIFY THAT I NAVE READ ANO E%AMINED THIS <br />' APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOFK WIL. �E COMPlIEO WITH WIiETfiEF SPECIFIED HEREIN OR <br />NOT. iHE OFlANTING OF A PERMIT DOES 40T PRESUME TO GIVE <br />Ali1HORITY TO VIOLATE OR CANCEL Tf'E PflOVISION UF ANY <br />OTriER STAiE OR LOCAL LAW REGUiATING JCNSTRUCTION OR THE <br />PERFORMANCE OF CONSTqUCTION. THAT I aM AUTHORIZED DY THE <br />OWNER OF THIS PROPERTY TO PEFFORM THE WORK FOR WH�CH <br />APPLICATION IS MADE AND I COMPIY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />x ��'�"�(f���/ �C' D' j �V <br />SIGN�lIIPE D�TE <br />CIfY 11U51NE55 L'�CENSC NO <br />MECHANICAL <br />NO. TYPE OP F.OUIPMENT FEE <br />A/C — A/HNDLG UNRS <br />� FORCED AIFl SYSTEMS ; <br />HEAT PUMP � <br />UNIT HEATEfiS ! <br />� % IYATER HEATER <br />�— WOOD STOVE <br />� ME-7AL FIREPLAI <br />L.__ <br />i fIREPLACEINSE <br />:_._ <br />GAS FIREPIACE <br />; GAS RANGE <br />, �� / E%HAUST AN <br />SUBTOTAL S <br />PERMIT E <br />TOTALFEE S <br />ri�HcirtcKruuunFn ,. / Irep InEr.6irtNo <br />VAC�NI SI1E FEF.S <br />❑YES ❑ NO p11IlDiNfi <br />SIIE Of BlD6rt I <br />PIUMpMG <br />BASEMENi MFCII�NIC.�t <br />❑YES ❑ NO -- <br />a0UI110�U1. Pl AN G�f Ge <br />0111C.11 <br />SIAI[ pIIIlO��+G SpPC1u06E <br />CITY OF EVERETT rum ic wonKs <br />LOCALSALES <br />TAX COOE IS 7105 7o7A� <br />H <br />