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,_., . . <br />APPLICATIG�1 FOR CONSTRUCT�ON PERMIT <br />' CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98207 • 259-8810 <br />f� DEMOLITION �1 COMBINATION f� BUILDING rl MECHANICAL � 1 PLUMBING f i SIGN <br />PROJECT ADDRESS �/ <br />% C � / ��YrJI i� /il /. �i � i 1 P �i�T /✓�i , <br />OMMER , MqLApDRESS CIiY I 21P <br />ARCIITCCT Oii OE9GN[R M�IL RDDRE55 CIN ZIP PHONE <br />GENERPt GONTIIRCTOR MIVI I10DRE55 CITY IIP PIIONE Si�TE LICENSE � <br />,�LF ly3SMG�lro,�lc� r',:�� r� f1 crl�.. �,5'.�.'3 �f�-�i� �✓/. <br />MECNnNICALCONTRACTOR MAIIADDRE55 CITV Z6' P110NE STRTELICEN$E� <br />M41L ADDRESS CI1Y ZIP PIIONE STATE UCENSE • <br />OES RIBE WORK nND SOUPRE FOOT�lGE� INVO,LVEO <br />/,;� �n •tliN_��� <br />PROPOSEp VSE OF BUILDING <br />l0T <br />TA% 1 D. <br />OF PROPERTY ISNOWN BELOw OR AttACN 7w0 COP�ES) <br />_ BLOCK OF <br />CONSTRUCTION LORN 1 EN�[fi. R�DRE55. TREPNONE NUMBER <br />WATER CLOSET <br />BATHTUB <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAH, ET <br />SUB TOTAL 3 <br />PERMIT $ <br />TOTALFEE $ <br />OFFICE USE ONLY: <br />SPTPACN REARSETBACK $IDESETBACN <br />USElONE ��TAREA — <br />❑EIGMT L�MITATION NO OF UWfLLMG <br />I1Nit5 <br />OCGUPRNCY MJ 01 S�ONiLS OCCUPRNj LOAD <br />Gt10�/ 1V I <br />FlPE �URM REO D :ti ASOY <br />N� <br />fIREGPRINNIERREOn �F�PON <br />�� <br />IYPFOffONST �l�H P PPOVC01 <br />V— �✓ .�,arE ii -7- <br />FEE <br />VAGANI SIiF <br />11VE$ tl NO <br />SIZ[ Of yBl�0(:.R I <br />�"V � <br />II1E5 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />HEATING SYSTEM: f l GAS f 1 ELECTRIC f 1 <br />ANU/RIONF NO <br />I HEREBY CERTIFV THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT ALL <br />PROVISIOtJS OF LAWS AND ORDINANCES GOVERNING TIiIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEfiEIN OR <br />NOT. TNE 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 OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I Ai✓ AU7HUHIZED fiY THE <br />OWNER OF Tl115 PHOPERTY TO PERfORM THE WORK FOR WHICH <br />APPUCATION IS MADE AND I COMPIV WITH THE STA7E <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />� f 1 ��� <br />x/ 1 f 1 � da,�, t L�(�Y"-� �1� <br />SIG RT RE l` OnTE <br />f,ITY 6USINE55 LICENSC NO <br />MECHANICAL <br />NO. 7YPE OF EOUIPMENT <br />A/C — AMNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — D.T.U. M E A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRVERS <br />RAIJGE HOOD <br />WATER HEATEF <br />WOODSTOVE <br />METAL FIREPLPCE <br />FIREPLACEINSERI <br />GAS FIREPLACE <br />GAS RANGE <br />PIAN CIIECK NUMBFR <br />OUII �MG <br />f•LUMOING <br />MFCH�NIGAL <br />ADDI I IONAI i'1 nN GHF.CN <br />on+en <br />$iR1E OUII O�NG SI/fIC11ARGE <br />rannr,wonK¢ <br />TOTAL <br />SUB TOTAL 8 <br />PERMIT ^m <br />TOTAL FEE $ <br />FEG RECPPT NO <br />VALUATION <br />3$u� <br />FEE <br />