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.� - <br />APPLICATIO.d FOFt CQNSTRUC7.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />�� fl DENiOLITION fl CQIABINATION fl BUILDING MECHANICAL �� PLUMBING fl SIGN <br />PROJECT ADDRESS <br />�% C9/ f�iicr'rn�e�� G(�a.., — <br />,..,.�.. ^ � _..-- --- <br />/S �GnNJan« <br />fENA�1T ���'( MAII,� RFSS <br />C f � l an �h <br />4RCHITECi0RUE51GNEfi MNI.AODFESS <br />Fl ONTIi�CTOR MA1 AOOf1E55 <br />/�/Y1L�[K(�' �f �' <br />. ECHANICALCONTRACTOR MAI DPE55 <br />a <br />PLUMBINGCONTRACTOR MAIL���RESS <br />LONTRACT PRICE OF WORK � l.�� <br />�t <br />DESCRI9E WORK ANO SOII�RE FOOT�GE INVOWED <br />G <br />�� <br />LEGAL �ESCfiIPTION OF PROPE�TV ISHOWN BELOW OR ATTACH TWO <br />�pT BLOCK ur <br />PFRCELTA%LD.NUMBER <br />CONSTPUCTIONLVai:LFN�ER.A��RE55.TELEPNONENUMBER <br />TYPE OF FI%TURE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAU�DRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ET <br />FOR OFFICE USE ONLY: <br />fRONT SFTOACN REAp SETDACN <br />USFZONE LOTAREA <br />❑EIGIITLIMITATION NO.OFDWELLII <br />UNILS <br />OCGUPANCY NO Ot S10PiE5 OCCUPANT L0� <br />GPOUP <br />i�EO'n <br />or <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE $ <br />CITY <br />1 Ah� � <br />FEE <br />SIDE SETOACN <br />VACAN�SI�E <br />(lYES f' NO <br />j�p �/ '/ 1'HUNt <br />`�fOn �` ���3 � <br />nr <br />srnre ucr.Nse . <br />Z�p PHpNE STATEIICENSE+ <br />Z;P PHONE STATEUGENSEx <br />HEATING SYSTEM: i>CGAS fl ELECTRIC f-1 <br />CONTACTPERSON�NDPNONENO. <br />� HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHE�fHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OH LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTIOR. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS 'AADE AND I COMPLY WITH THE STATE <br />CONTRAC( RS 1827 RCW AND 296200 WAC. <br />ti� �- ��n�-� �3 9G <br />SIGNFTURET� � DATE� <br />pTY OUSINE55 LICENSE NO. <br />MECHANICAL <br />N0. TYPE OF�EQUIPMENT FEE <br />--� <br />A/C—A/HNDLG UNRS—H.P. ' <br />FORCED AIP. SYSTEMS — B.T.U. M[.A. ; <br />HEAT PUh1P ' <br />UNIT HEATERS — B.T.U. M ; <br />CLOTHES DRYERS � <br />VENTILATION FAN ' <br />AANGEHOOD � <br />WATER HEATER ' <br />WOOD STOVE � <br />METAL FIREPLACE (WOOD BURNING) � <br />FIREPLACE INSERT (WOOD BURNING) ' <br />GAS FIREPLACE � <br />GASRANGE <br />GAS PIPING , <br />SUB TOTAL S /" � <br />PERMIT S � � <br />TOTALFEE 5 / J <br />PL�NCIIECNNUN�FR � FE[ I f1ECEIPTNO. <br />C(�!il <br />� BOILOING <br />512E OF OLOG�f I <br />PLIIIAOING <br />BASEMENT MEO�ANICAI. <br />t1YE5 I'I NO <br />�OOIiION�L PI AN CMF.CK <br />OTNER <br />STNE OUII�IN[ SURCHARGE <br />or CITY OF EVERETT �unur,wonKs <br />LOCALSALES <br />t- S(, TAX CODE IS 3105 TO7AL <br />