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APPLICATION FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> DEMOLITION fl COMBINATION fl BUILDING f-1 MECHANICAL f� p�UMBING fl SIGN <br /> PRO�CT AD RESS , � � <br /> e � � �� � �rf � � �3 3S3 -J o <br /> O� ER � �� M�UDRE55 � dTY ZIP" PHONE �� <br /> °'�� L Q Md uS <br /> TENANT MAILAUORE55 CITV zlP PIIONE <br /> ARCHITECT OR�ESIGNER MAII.pODRE55 QTV IIP PHONE <br /> GENERFLCONiMCTOR MAILADDRE55 �IIY 21P p110NE STATEUCENSE� <br /> MECHANICALCONTRACTOR MAILADDRESS CITY ZIP PIIONE STATELICENSE� <br /> PWMBINGCONTRPCTOR MAILAODRE55 CITY ZIP PHONE STATEIICENSE� <br /> CONTR�CT PRICE OF WORK <br /> HEATING SYSTEM: �l GAS f-1 ELECTRIC fl <br /> DESCRI E WORK ANO SOU RE FOOTA E�NV LVED CONTACT PERSON AN�PHONE NO. <br /> Ati <br /> � e v oi 2 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS <br /> PAOPOSEO USE OF BUIIDING APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK W�IL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRIPiIONOFPROPERTY�SHOYMBELOWORATTPCHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> tor .S BLOCK " oF � f AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> 1 OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> • Z OI. IU s/J PERFORAIANCE OF CONSTRUCTIUN.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WNICH <br /> �A..�e 78' APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> cet LD.NOMBER CONTRACTORS LAW 1 , 7 AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER.ADDRE55.TELEPNONE NUMBER x 9 Z S� S �f <br /> SIGNATURE DATE <br /> CI7Y BUSINE55 LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF flXTURE OR ITEM FEE NO. 7YPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNfTS—H.P. � <br /> BATHTUO ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES ORVERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAV ; RANGE HOOD ; <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ' GAS PIPING <br /> i EXHAUST FAN � <br /> i � <br /> � �� <br /> � � <br /> .�'iU8 TOTAL S � SUB TOTAL 5 ' <br /> PERMIT S � PERMIT $ � <br /> TOTALFEE $ ' 10TAlFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> fRONT SFTPRCN RE4P SETBACK SIDE SEiBRCK PIAN CII CK NUMOER �EE AECEIPT NO. <br /> /- 7 <br /> 6'CCY ��J <br /> usezoNe IOTAqE� VnCANT5ITE FEES VALUATION FEE <br /> f1YE5 fiND OUIIUING � <br /> - i <br /> IIEIGHT LIMITA710N NO OF DWELLING SI2E OF BLOGT � � <br /> UN11S PLVMBING � <br /> { <br /> OCCUPANCY NO O�SfORiES OCCUPANTL04D BRSEMENT i <br /> fAOUP MECH4NIC�L � <br /> IIYES fl NO � <br /> PDDIIION�L PIAN CH[CR i <br /> FIRE ALARM REO'D RF.ASON i <br /> --� <br /> i <br /> Oi11Ef1 i <br /> FIPF.SPRINKI.ERREOD REASON i <br /> STAIE BUILOMC SURCIURGE � <br /> rvveorr,aNst vinNsnrrnovenov CITYOFEVERETT ruri.�cwonKs ' <br /> LOCAL SALES �-- <br /> untE TAX CODE IS 3105 TOTAL � <br />