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APPLICATII�N FOR CONSTRUCi .ON PERNi�T� <br />CITY OF EVEREIT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETi, WA 98201 • 259-8810 '��" <br />� <br />Ci pEMOLITION �i COMBINQTION � BUILDING ❑ MECHANICAL f� PLUMBING fl SIGN <br />PROJECT ADDRESS <br />- �o � �L�S� �C ��/eR��� _.��� <br />OWNER MRI�ApDRES$ GITV ZIP PHOYE <br />�/�m e S I� Ci� � n1 j oc� �4 Ca�d; �}��e �?/��s/T 9� 2�3 ?�:� -� �S P <br />TENRNT MAILA�ORE55 Gi! ZIP PHONE <br />(�:.0 .v P i <br />ARGHITECTORDESIGNER MAIL/�DRE55 qTV ZIP PMONE <br />GENERRICONTRFGTOR MaILAWRE55 CITV 21P PHONE $TATELICENSEI <br />".cU nl P �� , <br />MECHANILA�CANTRACTOR MRILADDRESS GTY ZIP PHONE STATEUCENSE� <br />PWMBMGCONtAACTOR MAILADDRESS <br />WORK AND SOUAFE FOOTA,^.E INVOLVEO <br />� <br />COPIES) <br />LOT � BLOCN � <br />3�7�J'C7d0-�/b �Oooz <br />CONSTPUCTON LOAN LENDEii, ADDRESS iELEPNONE NUMBER <br />PLUMBIN6 <br />OF Flf(TURE OR 17EM <br />BATHTUB <br />LAVATORY (WASH BA: <br />SHOWER <br />KITCHEN SINK & DISP <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTEFiS <br />SUBTOTAL S <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETO� � J REAR SET�ACK J SIUE SETBACN <br />/ iK' L <br />USE ZONE <br />HEIGNT <br />qTV <br />FEE <br />21P PHONE STATEIICENSE� <br />HEATING SYSTEM: fl GAS f�7 ELECTRIC ❑ <br />GONT�CT i�ER504 AN� PHONE N0. <br />I HEREBY CERTIFV THAT I HAVE READ AND E%AM�NED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />iJOT. THE GRANTING OF A PERNIT DOES NOT PRESUME TO GIVE <br />AUiHORITY TO VIOLATE OP CE NCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGJL".TiNG CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTIOI l THAT I pM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOF WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT?ACTORS LAW 1827 RCW AND 296200 WAC. <br />� <br />/ .7 , '/„/Ss <br />X .i-�/7. �, :-rv,a � Q�h+ <br />SIGNA� C � DATE <br />CITV BUSINE55 L�CENSE NO. <br />MECHANICAL <br />NO. TVPE OF FI7(TURE OR ITEM FEE <br />A/C-AMNDLGUNITS-H.P. --!— <br />FORCED AIR SYSTEMS - B.T.U. M E.A. ; <br />HEAT PUMP <br />UNIT HEATERS - B.T.U. M <br />C�OTHES ORYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE I <br />FIREPLACE ItJSERT <br />GAS FIREPLACE <br />GAS RANGE <br />SUBTOTAL $ <br />PEF;MIT S <br />TOTALFEE S <br />PUNCHECKNUMBEP � IFEE �i IAECEIPTNO. <br />� LOTRREA VRCRNTSITE YCCS <br />�� f7YE5 fl NO <br />OUILDINO <br />fqTION / / NNiOFbWcLIJNG SIIEOFBLDGRI. <br />7/_ �G PWMOINO <br />v� r <br />NO OF STOPIES OCCUPANT LOR� 9ASEMENT � � MECIIANICAL <br />❑YES ILRO <br />PEO'D REASON AUbIPGNAI.PLANCHECK <br />� OTNER <br />lEB REO'0 REASUN <br />J �IATE OUItDINO SURCNARGE <br />Nsr. auNsnrano EOOY CITY OF EVERETT rueucwonKs <br />� Fi- LOCAL SALES <br />. �_ I ,,..� i��. /9ti TAX CODE IS 3105 TOTAL <br />.� <br />�� <br />• <br />