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APPLICATIG�1 FOR CONSTRUC7.dN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETf', WA 98201 • 259-8810 <br />.FI DEMOLITION fl COMBINATION �DING fl MECHANICAL r� pLUMBING fl SIGN <br />PROJECT ADDRESS <br />FRCHITECT <br />-�_.� <br />fV � �.tw -4' <br />cirr nr <br />s� �,,�-vci( �k ll <br />CITY ZIP <br />ci.v zir <br />� <br />PHONE <br />-V. ----. �� v... ur �'n�rvt Jlqlhll6ClVJt� <br />MECHM1NICALCONTR�CTOR MAILFO�RE55 (;ITV ZiP PIIONE STATEIICENSE� <br />vLUMtlMGGUNiHPGTOF MAILA�D(7ESS <br />CONTRACT PPICE OF WORK <br />��. � � � <br />DESCRIBE WORK AN SOURRE FOOTAGE INVOLVEC <br />ra w�o � D v�o X <br />���5 <br />�ti `_._.......5 �i 1Q s <br />LEGAL DESCRIPTION OF PqOPERTY (SIiOWN BE <br />LOT BIOCN <br />PARCELTA%I.O.NUMBER <br />CONSTRUCTION LOpN IF.NDER. AOORE55. TELEPHONE NIIMBER <br />PLUMBING <br />NO. TVPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />IAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />OISHWASHEF <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SENVICE — BAR, ETC.) <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBALN RERi15ET�ACK <br />USEZONE IOTAREA <br />HEIGH7LIMITATION NO.OFOWELUNG <br />UNIiS <br />fIREpLAPMREO'D RE�SON <br />Yr� � <br />FIRFSPR�IN�K�LE"RPEO� f1E�/i.-O�N <br />16�/ �!' <br />TYPE OI' CONS� PI ANS A <br />� JM <br />omE <br />SIOE SETBACN <br />CIN ZIP PHONE STFlE UCENSE � <br />HEATING SYSTEM: fl GAS f� ELECTRIC f� <br />CONTr1CT PERSON AND PHONE NO. <br />tizn► � �, v,� r-� �r�o _ �z� � <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER Sf ECIFI[D HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT FRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION O:� ANY <br />OTHEF STATE OR LOCAL LAW REGULAT�NG CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTIO�. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APP ION IS MADE AND I COMPLY W�TH THE STATE <br />CO RAC RS LAW 10.27 AND 296.200 WAC. <br />r.� � � F �- <br />X <br />SIG FTURE OATE <br />CITV BUSINESS IICENSE NO. <br />NO. TYPE OF EOUIPMENT FEE <br />A/C — AMNDLG UNRS — H.P. <br />FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACC INSERT (WOOD BURNING) <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAW <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />PLANCIILCNNJ�MO��' I re��� �aa I RELEIPTNO. <br />�lY9 / <br />VAC�N7 SI7E rees <br />f1YE5 (i NO OUILOING <br />S12E OF BLOGRI <br />� � �IUMpING <br />�SEMENT MECIInNICAI <br />llYES I1 N'J <br />�D6111pNAl. FIAN CII[CN <br />OTHER <br />- 5 iAi E OOILOINO SUf1GHnfiGE <br />jv CITYOFEVF.RETT rueiir,wonres <br />IOCAL SALES <br />, TAX CODE IS 3? OS TOTAL <br />