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APPLICATI�1 FOR CONSTRUC JON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />rl DEMOLITION fl COMBINATION fl BUILDING f� MECHANICAL �� PLUMBING SIGN <br />PROJECT ADDRESS / / �F / _ ` TI <br />� � � <br />� ? /1.,�I �f l / _ J � y �. <br />�NMER M�ILAODRESS CITY 21P p110NE <br />tVtE1-S�N INV• po �p,ox %052�{ 5E�lTrCF 9srin� .— <br />. ___..,__I. _n.._..,......... �.,......vvr�caa CI1Y <br />N �/ � <br />�ENER�LCONTMCTOR M���ADDfiESS CIIY <br />AM,E2� 1v. NEnN `Po�ox �i31 -rAcr,, <br />MECH�NICALCONTR�CTOR MAIlA00RE55 g�ry <br />N �R <br />c_o <br />OESCf11BE WORK �NO $OWRE <br />or <br />= aa <br />�ot� 1A17ER�11V �t�B1OCN O/2 D"�oFJ'�R 1 <br />� �'?i.,5.+'�. N G I-3G� �RcG fE <br />�cu� � �u oF w-r B� <br />PANCELTA%I.D.NVAIBER <br />y9oa -oi.2 �no7-oio9 �r�fBoa -o� <br />CONSIRUCTqN Lf1AN LENOER,AOORESS. TElEP110NE NUMAER <br />TYPE OF <br />WATER CLOSET� <br />BATH7UB <br />LAVATORV(WASF <br />SHOWER <br />KITCHEN SINK 8 <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHE <br />DRINKING FOUNTAIN <br />FIOOR ORAIN <br />ITEM <br />SUB TOTAL E <br />PERMIT S <br />TOTALFEE E <br />FOR OFFICE USE ONLY: <br />FRONT iETP�CR REM SETBACK <br />USEZONE LOf�REA <br />❑EI611TLIAlIUTION qO.OFOWELLING <br />IINI�C <br />OCGUi'ANCY Iq Of SI011IF5 OCCUPANT LOAO <br />nroo <br />oae � 2 - <br />� <br />SIDE SEtB�CK <br />VACANI $I1F. <br />f1YE5 fi NO <br />71P <br />?!� <br />PIIONE <br />7�� PNONE STATEIICENSF � <br />HEATING SYSTEM: f'I GAS rl ELECTRIC fl <br />CONT4CTPERSONANDPNONENO. ._ . �. .. <br />( :c1,:1 1;���'7- i�I�ll;� <br />, _ _ <br />I HEREBY CERTIFV THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CJRRECT AlL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIIJ C` � <br />NOT. THE GRANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAI LAW REGULATIN6 CONSTRUCTION OH THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPIY WITH THE STATE <br />CONTRACTOR� LqW 18.27 RCW AND 296200 WAC. <br />x �LJ � d� /� /S�S <br />SIGN�TU E O�iG <br />C — <br />CITY OUS�NESS LICENSG NO. <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />A/C—AMNDLGUNRS—H.P. —�— <br />FORCED AIR SYSTEMS — B.T.U. M E.A. � <br />HEAT PUMP —�— <br />i <br />UNIT HEATERS — B.T.U. M � <br />CLOTHES DRYERS ; <br />VENTILATION FAN � <br />RANGEHOOD � <br />� <br />WATER HEATER , <br />WOOD STOVE � <br />METAL FIREPLACE (WOOD BJRNINGf : <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />PIAN CIIECR <br />OUIIOMG <br />StZE OF OLOG�t I <br />P111M01NG <br />PASEMENf MGCII�NIC4L <br />IIYES I I NO <br />�DDIIION�L PI �N CIIf.CN <br />on�en <br />. srmenunrnrinsuncimnce <br />CITY OF EVERETT runnc wonKs <br />LOCALSALES <br />� TAX CO�E IS 3105 TOTAL <br />PERMIT $ <br />TOTALFEE S <br />fF.E f1ECEIPiNO. <br />�� /�) <br />n <br />