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APPLICATIOrI FOR CONSTFiUCTiON PERIINIT <br />CITY OF EVERETT • BUILQING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />f7 DEMOUTION I-1 COMBINATION I-1 BUILDING i 1 MECHANICAL rl PLUMBING f l SIGf� <br />PROJECT ADDRESS <br />� <br />► �� �� �-� �l <br />CITY _ ZiP PH <br />21P <br />-3 3ss - <br />PRCHITECTOPDESIGNER MAIIADORE55 CITY zip AHONE <br />GENERALWNTqACiOR MAILAODRESS QtV ZIP P�ICNE SiRTE�ICENSE� <br />MECHANILALCONTNACTOR MAILApDFE55 CITY ZIP PHONF. STATELICENSE� <br />PLUMBINGCONIRnLiOR MAILA�DRE55 CIN Z�p PHONE SiATELIGENSE� <br />DESCRIBE <br />�or <br />BLOCN <br />BELOW OR ATfACN TWO COPIES) <br />PAF.CEITA%LD.NUMBER <br />CONSTRUCTION LORN LENDER, ADDfiE55. TELEPIIONE NUMBER <br />PLUMBING <br />NO. TYPE OF fl%TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWNSHE9 <br />LAUNORYTRAY <br />CLOTHE3 WASHER <br />URINAL <br />DRINfCING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PqEVENTEFS <br />$�NK fSERVICF — FAR "Tf: 1 <br />SUB TOTAL S <br />PEFMIT $ <br />TOTAL FEE 3 <br />FOR OFFICE USE ONLY: <br />FHONTSEiflACN REAR SFT�M1LK <br />use zoNe <br />IIEIGIIT LIMITATION <br />OCGUPANCY NO 0[ SIOPiES <br />GROUP <br />FIRE AtARM qE0'D <br />FIRE SPRINKLEq REO� <br />TVPE OF f,ONST <br />IOTARrA <br />NO. OF OWELLING <br />UNII$ <br />UATE <br />$I�E SCTBRCK <br />\'ACRNi SIiE <br />f1YE5 f i NO <br />SIZE UF BLOGRI <br />f1YE5 fl NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />HEATING SYSTEM: Cl GAS I-1 ELECTRIC fl <br />CONTACT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED 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 WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER fiTATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFO�iMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNEH OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONiRACTORS LAW 18.27 RCW AND 296200 WAC. <br />x��s°E��s�lil,B'.� /O /a -9,s� <br />NATURE OATE <br />CITV BOSINE55 UCENSE N0. <br />MECHANICAL <br />NO. TVPE OF EOUIPMENT FEE <br />err. _ en.iurn r. i wirs — u o ; <br />AIR 5Y5 i EMS — B.T.U. M E.A. <br />1��7il��:1 <br />METAL FIREPLAi <br />FIREPLACE INSE <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE S <br />PUNCVI UMBER I �EE i RECF.IPTNO <br />�%�?7�- <br />OUIL�Mfi <br />PLI1MpING <br />MECIIANICAL — <br />ADDIIiOHAL PLAN CMECN <br />OTMER <br />SiATE BIIIL[lRlG SURCIIARGE <br />nunur, woares <br />TOTAL <br />