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APPLICATIV�i�I FOR CONSTRUCT ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVEAETT, WA 98201 •259-8870 <br /> (l OEMOLITION Cl COMBINATION �l BUILDING f� MECHANICAL K"��UMBING f 1 SIGN <br /> PROJ CTADDRES <br /> ? c / '�� �S <br /> o`�Lt+ER� ,/� M�ILRDDRE55 cm zir r��oHc y p.�i,� <br /> [�U/J�nJTI/?�_ .��U`O�.s.� <br /> TENRNT IAAILADDRF55 QTV plP PIIONE <br /> IIRGNITECT OR OESIGNER MRIL RDORESS QTV D� PNONE <br /> GENE�AL CONiRAG10R MRILAOOOESS GT� 21P PIIOYE $7ATE IICENS[� <br /> MECHANICALCONTRACiOR MAILADbPE55 (;ITY 71P PIIONE $TRTELICENSE� <br /> PLU BING ON7RACTOR MAI�AODRE55 CITY 71P PHONE STATEUf,FNSE� <br /> � 9� �9G/�� ./�.I��/c�Kc�'smp <br /> cor+rn�cT rmcE oF wonK <br /> HEATING SYSTEM: I I GAS f I EIECTRIC f� <br /> OESCRIOE VIORK ANO SOVAqE FOOTAGE b1VplVEO CONT�CT PERSON ANO PNONE NO <br /> I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS?YPE OF <br /> WORK WILL BE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br /> LEG�LOESCRIPTIONOFPpOPERTY(SNONMBELON'ORRT7ACNTWOCOPIES� NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> toT a�ocK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTIDN OR THE <br /> PERFORMANCE OF CONSTqUCT�ON.THAT i AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PARGELTAXID.NUMBEa CO SLAW1b.27R . 00'NAC. <br /> CONSTPUCTON LO�N LENOER.ADORESS.lELEPNONE HVM9ER xC r `0��7 S <br /> c1 f-�• <br /> AUSINF55 LICENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TVPE OF FlI(TURE OR ITEM FEE NO. TYPE OF EGUIPMENT FEE <br /> WATERCLOSET(TOILET) � /VC—FVHNDLCaUNITS—H.P. � <br /> BATHTUB � FORCED AIR SVSTEMS—B.T.U. M E.A. ' <br /> LAVATORV(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNITHEATERS—�.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRVERS ; <br /> DISHWASHER � VENTILATION FAN . � <br /> LAUNDRY TRAV ; RANGE HOOD ' <br /> CLOTHES WASHER � WA7ER HEATER � <br /> URINAL WOOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR ORAIN � FIREPLACE INSERT(WODD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> � GI15 PIPING � <br /> � EXHAUST FAN , <br /> i � <br /> � � <br /> � <br /> SUB TOTAL $ � SUB TOTAL 5 � <br /> PERMIT $ i PERMIT $ � <br /> TOTALFEE $ � TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> lRONT SF.TpACN RE�R SF.TBRCK SIDE SETBRCR i'L�N CHEC `l1M{F.q fE[ RFC[IPT NO <br /> 1�a <br /> USEZONE IOTMG VpCRNISIfE FEES VALUATION FEE <br /> I I VES 11 NO Ol11lDMG i <br /> � <br /> HEIGf/T LIMIIATIDN NO OF OWELLING SIZE OF BLDGR I � <br /> UN115 PlUM01NG '� i <br /> OCCUPANCY NO Oi 51(MitCS OCCUPANT LOAO BASEMENT � <br /> �.qppp MECHANICAL � <br /> IIYES II NO i <br /> FlRE AUfiM REOD p[ASON AD�I710NTI.{RAN CHf.f.K � <br /> O1NEB � <br /> FIRESPPINKLERRG00 PEASON • <br /> i <br /> S1A1C BU�LDMG SUqC11ABGE � <br /> trreoFr,or+sr rinNsarrnoveoov CITYOFEVERETT r��ei�r,won�s ' <br /> LOCAL SALES — <br /> �ATE TAX CODE IS 3105 iOiAL ', <br />