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APPLICATION FOR CON�TRUCTION PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOUTION �l COMBINATION I'l BUILDING �MECHANICAL r� pWMBING fl SIGN <br /> PROJECT ADDRESS <br /> n � � <br /> � .� <br /> ��ER MRILRODRESS � ` � <br /> ��TM /t'110NE �) <br /> TelL�-�. r�, 1 � 1��G ) �I�( 1 ziP�� �V.-(��- �b Oj .����7 <br /> MAIL A0�$ /� CITV <br /> ��- //�^^ � �HONE <br /> ARCHRECT OR OESIGNER MAIL AD�RE55 � 'y` �� <br /> ��TY IIP PNONE <br /> �G NEf1AlCONTRACIOR MAIL OOf1E5S �IIY <br /> �� ' A\ 1\I�� ��r _�'� ��� �� )�� ��� ZI� y� n PIIONE S1ATEfICENSE"�,-7 <br /> ) l /� � " j l/ 1Lcirv�-�-u�-`"�V��.C�f-�1—:=1�'_1�=� 1—`v� - <br /> MECN NICAL CONTRACTOfi MAI ADDR � <br /> �A � ��a�. � ��sff�oN�� �..a_ <br /> PLUMBINGCONTRRCTOR MAILADOPESS Cltt <br /> ^^ � Z�P PHONE STA7E LICENSE• <br /> / / t <br /> ' CONTR�CiPR�CEOFWORK <br /> ; O �- HEATING SYSTEM: f GAS I-1 ELECTRIC f� <br /> DESCRIBE WOqN AND SOUARE FOOiAGE INVOLVED <br /> . CONTACTPERSONANDPII NENO. � . <br /> '_� G� - � � <br /> N ' � - <br /> . . I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> . PROPOSEDUSEOF6UIl0ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.qLL <br /> . PROVISIONS OF LAWS AND OROINANCES GOVERNING THIS TYPE OF <br /> . LEGALOESLqIPTIIXJOFPROPERTY�SHOWNBELOWIXiATTACH7WOCOPIES� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERMIT �OES NOT PRESUME TO GIVE <br /> - ��T B��K oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW qEGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPIICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCELTA%I.D.NUMBER CONTRACTORS LAW 1 ' CW AN 296200 WAC. <br /> CONSTRUCTION LpAN LENDER.ADDRESS.TEIEPHOONE N�ER D / /� / <br /> x G C� <br /> SIGNATURE DATE <br /> CITV BVS�NE55 UCENSE NO. <br /> PLUMBING MECHANICAL • <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EpUIPMEN7 <br /> WATER CLOSET(TOILET) — FEE <br /> ' A/C—A/HNDLGUNRS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T,U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP '�— <br /> SHOWER ' <br /> ' UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS <br /> DISHWASHER � <br /> ' VENTILATION FAN <br /> LAUNDRY TRAV ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL � WOOD STOVE , <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) ' <br /> FLOOR DRAIN ' <br /> ' FIREPLACE INSER7(WOOD BURNING) � <br /> BACKFLOW PpEVENTERS � GAS FIREPLP.CE ,� � <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE � <br /> � <br /> i GAS PIPING <br /> � <br /> � EXHAUST FAN � <br /> -- ' <br /> i <br /> � <br /> � � <br /> � <br /> SUB TOTAL g � SUB TOTAL S ' <br /> PERMIT 5 , ' <br /> PERMIT S i <br /> TOTAL FEE $ � TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSFTPRCN REARSETBRLK SIDESET6ACN PLANCNFCKNUMAEB / FEE REf.[IPTNO. <br /> USEIONE tornnen VRCANISITF FEES VALUATION FEE <br /> IIYES fl NO <br /> -- OUI(�ING � <br /> HEIGH7L�MI7ATION NO.OFDWELLING SIZEOFBLOGR.I � <br /> UNITS � <br /> PIUM�ING i <br /> i <br /> OCCUPANCY NO O�Sf09iES pCCUPANiLOAD BRSEMENi � <br /> GROUP MEC114NICAL <br /> f11'ES Il NO � <br /> FIPEALMMREO'D i1FRS0Y ADO1110NAI.f'l�NC11F.GN <br /> ou�en � <br /> FlRF SPRINNIER R�p�p REASON � <br /> i <br /> STNE OUIIDWG SUIILIIAt1OE i <br /> ♦ <br /> TYPEOPf,ON$T P�ANSAPPpOVE00Y CITYOFEVERETT rumir.wonKs <br /> LOCAL SALES __,__ <br /> oarE TAX CODE IS 3105 707AL <br />