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APPLICATII..� FOR CONSTRUCI.ON PERMIT � <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 '���" <br />I-1 DEMOLITION i 1 COMBINATION !� BUILDING I-1 MECHANICAL fl PLUMBING rl SIGN <br />PROJECT ADDRESS _ , , , � _ � � _ _ , � n <br />GENERALCONiRAGTOR MnIUDD(1E55 CITV 21^ PHONE STATELICENSE� <br />` �"� � ipTE IICFNSE � <br />MECNANILALCONTRACTOI7 MAILRDDRESS CITY ZIP PNONE <br />PLVMBINGCONIRAC70R MAILADDRE55 Gltt ZIP PNO'.t STATEUCENSE� <br />CONTfiPCT PRICE OP WORK <br />DESCPI6E WORK ANO SOUARE f-0OTA6E INVOLVE� <br />r <br />�d7C,5�';�i '�(_� 1. 7�� <br />PRO E� VSE OF BUIL � <br />LEGRL DESLFIPTION OF PROPENIY �SNOWN BELOW OR ATTACN' <br />�or e�ocK oc <br />PARLELTA%I.D NUMBER <br />7�99 Br, -r/7"GOD <br />CONSTI7UCilON LOPN LENOER, A�DRE55. TELEPHONE NUMBER <br />PLUMBINCa <br />Np, TVPE OF FIXTURE OR ITEM <br />WqTER CLOSET(TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KIICHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL _ <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAF. El <br />SUB TOTAL S <br />PERMIT 9 <br />TOTAL FEE S <br />FOR OFFICE USt ONLY: <br />FRONTSEiOPCN RE�� SETOACK <br />U�E20N[ <br />NE�GHT LIMITATION <br />OCCUPANCY N06570AiE5 <br />GPOUP <br />FIRE AIARM RCO'D <br />LOT Af1EA <br />NO. OF OWELLINQ <br />UNITS <br />SIUE SETBALN <br />VAGANT SITE <br />i'lYES fl NO <br />SIZE OF BLCGRI. <br />❑YES fl NO <br />C�TY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />HEATlNG SYSTEM: ❑ GAS f7 ELECTRIC ❑ <br />CONTRCT PER504 ANU PHONE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND ExAMINED 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 SPECIfIE� HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE ��R CANCEL ThIE PROVISION OF ANY <br />OTHER STATE OR LOCAL LA'N REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTFlUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WI1H THE StATE <br />CONTPP.:TORS LAW 1827 RCW AND 296.200 WAC. <br />SIG PT TE � �� <br />QTV BUSME55 L ENSG N0. <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />A/C — AMNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />FAN <br />WATER <br />WOOD <br />GAS FIREPLAC <br />G�S RANGE <br />(+�S FIPING <br />EXHAUST FAN <br />SUBTOTAL $ <br />PEFMIT 5 <br />TOTALFEE $ <br />PIANCNECNNUMOFR FEE IRECEIPT110. <br />BUILDING <br />PWAI�INO <br />MECIIAMCAL <br />AODITIONAI PIAN CHECK <br />OTI/EP <br />STATE BU�IDING SURGHMGE <br />ruaucwoaKs <br />TOTAL <br />