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APPLICATIO� FOR CONSTRUCT�ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION IYCOMBINATION fl BU!LDING C7 MECHANICAL �� PLUMBING fl SIGN <br />PROJECT ADDRESS <br />S�3o <br />OWNER MMLADORF <br />MAIL ADDRESS <br />�A <br />LIIY 21P <br />ARCHITECTOHDESIGNER MAILADDRE55 CITY 21P PIIONF <br />Si4ME <br />GENERALCONTRACTOq MAILAODRESS piV 21P P��ONE SIATELICENSE� <br />MAIL pDDRE55 <br />cirv <br />YIIVht <br />PLUMBING:ONTRACTOR MAI�ADORE55 CItV ZIP PHCY"e STATEUGE4SE• <br />CONTMCT PPICE OF WORN <br />DESCRIBE WORK�VD SOUARE FO'JTAGE INVOLVED <br />��S/G 32� <br />PROPOSED USE OF BUIIDINO <br />LOT- BLOCK OF, <br />/ irf � / /li /�ir✓ <br />a��nacN <br />� <br />LOAN LENDER. ADURESS. TELEPNUNE Nll!AOER <br />aLUM81NG <br />NO. TYPE OF <br />WAT[R CLOSET <br />�]_ BATHTUB <br />SHOWER <br />KITCHEN SINK 6 DISP <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN' <br />SINK (SERVICE — BA <br />OR ITEM <br />� _ SUB TOTAL <br />PERMIT <br />TOTAIFEE <br />FOR OFFICE USE ONLY: <br />FHONT SETB�CK � REA� SETB�CN � <br />�� <br />USE20N� — / LOTAREA <br />v � <br />/ <br />IIEIG�IiLIMITATIOjJ _ / NO OFOWELLING SIZE <br />/J�iy UNIIS '1 <br />!/C./ <br />OCCVPANCY tYJ Oi510NE5 OCCUPANILOAD <br />°`�}°"� 2 N�A <br />DA'E <br />FEE <br />—S� I !_ <br />al � <br />SiOE SETB�CK / <br />� <br />VACANT $ITE <br />f1YE5 f1 NO <br />JF BLDGRI <br />39 sf Lw��a <br />� zz SF GnnAW <br />BASEMENT �� � <br />f1YE5 I4'NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAl( CODE IS 3105 <br />HEATING SYSTEM: ❑ GAS f�ELECTRIC fl <br />CONTACT PERSON ANO PHONE NO. . , <br />I HEREBY CEFiTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINC CO�ISTRUCTION OR THE <br />PERFJRMANCC OF CONSTRUCTION. THAT I AM .1UTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAbY 18.27 RCW AND 296.200 WAC. <br />P G�, ��9.5 <br />SIGNATURE DAIE <br />o29LSo <br />pTY BUSINESS LICENSL NO. <br />MEC�!4NICAL <br />NO. TYPEOFEQUIPMENT FEE <br />A/C — MiNDLG UNITS — N.P. : <br />FORCEDAIRSYSTEMS—O.T,U. M E.A. ; <br />HEAT PUMP ' <br />UNIT HEATERS — B.T.U. M _ <br />VENTILATION FAN <br />FANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />MEl'AL FIREPLACE <br />FIREPLAr,E INSER� <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE S <br />�.� /..3� <br />PIAN CIIECN N MUER FEF �GCE�PT NO. <br />�i �i_�i_ '�/)/ � I/� <br />omiou+o �'�,jUO � __ <br />awramr+c /p 9 � �'7 <br />----r-- <br />MECMaNICAL <br />�� ���J <br />/ // �/ .'� <br />AOD� i IONM PI�N CNECN � <br />on�en �� D �� <br />$TAIE OUq01NG SURCIInfiGE � � -� � <br />_ _��( <br />PUBIIC, WOi1N5 lYG�� ��" � <br />TOTAL �7 / 1 �J <br />