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APPLICATlt,.� FOR CONSTRUCI.ON PERM�T �}s <br />CITY OF EVERETT • BUILDING DIVISION �/'��1.� <br />3200 CEDAR STREET • EVERETT, WA 9f1201 • 259-8810 `C'�'��¢" <br />�l DEMOLITION f 1 COMBINATION rl BUILDING MECHANICAL f"! PLUMBING �l SIGN <br />PROJECT ADDRESS _ _ _ _ 1 ) <br />OVPoER 11AILRDOR[55 � CITY ZIP PHO4E <br />TpeN Da.vIS MZ�DD5:2 f�v� Fvcrt�{- YZS'�o/ Z58-9/?7 <br />PRCNIT[�TOPOESIGNER MAILAD�FcS$ CIIY Dv PHONC <br />GENER4LCONTRNCT(Ki IAAILADORESS CItV ZIP PHONE � AiEIICENSE� <br />Fn u�v D/FT� nw c e^ s t- Co !0/31 R I"o� S.F ���rt�'i 9t?,?o 8 fote.vDCGoGGD <br />MECHANICALCONTRACTOR MAILADDAE55 <br />ZiP PHONE <br />i <br />PLUMBiYGCONiRAGTOR MAILApDPE55 CITY Zli� PHONE STATELIGENSE� <br />C TRhCT PRICE OF WOfiN ------- '/] �__ <br />�6,`100 !��m�� <br />_� �.ri�� <br />DESCR19E WORN AND SOUARE FOOTAGE INVOLVEO <br />Fnu�.Dci-�le�J wndt� cx%S1 <br />PROPOSED USE OF BL'��' DING <br />LEGAL DESCPIPTION OF PFOPER7Y �SHOYM �@LOW <br />�or 3/ t 32 BLOCK �_ aF_ <br />CONSIRUCTIONLOANLENDER.AU�RESS.TELEPHONE NUIIBER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR iTEM �-- <br />WATER CLOSET (TOIL[T) <br />BATHTUB I <br />KITCHEN SINK 8 DI; <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC <br />I SUBTOTAL 5 <br />PERMIT 5 <br />TOTALFEE 5 _ <br />FOR OFFICE USE ONLY: <br />FRONT SF.TAAGK � ��AR SETDACIN SIDE SET9AC�K <br />2 U `� —.2'-�,— <br />usezon�, �orn En vncnHrsirF <br />�„3 �� nvEs <br />HEIGIRLIh11TATION� NO.OFpWGL1.ING SIZEOFBLDG/TI <br />e /) UNIiS , _ _ <br />OCCUPANCY NO 0� $i0F1E5 I OCC�IPANT <br />GRObP I � I <br />FlREAIARMREO� REASC4 <br />�1 ° <br />FlRESPR1NKlERREO'0 REFSON <br />� <br />TVPE F CONST PI.nNS APf <br />� <br />�-IJ un;� I� <br />HEATING SYSTEM: Cl GAS Cl ELECTRIC f-1 <br />LCYTACi PEPSON AND PHONE N0. <br />I HEREBY CERTIFY THAT V HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE S4ME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AtlD ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLI�D WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVF. <br />AUTHOAITY TO VIOLATE OR CANCEL THE PROVISION OF AN'f <br />OTHER STATE OR LOCAI. LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CO�lSTRUCTION. THAT I AM AUTHORIZED B'! THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHI�H <br />APPLICATION IS MADE AND I COIdPIY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />x <br />�ay2 ���.¢.�' l/-�.z- 95i <br />SIGNATURE � D/7E <br />QTY BU9NE55 LicFNSL NQ �J <br />MECHO,NICAL <br />NO. TVPE OF FIXTURE GR ITEM FEE <br />T <br />NC — A/HNDLG UNITS — H.P. `_ <br />FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br />HEAT PUMP � <br />UNIT HEATERS — B.T.U. M ' <br />CLOTHES DRYERS i <br />VENT;LATION FAN ! <br />Ri�NGE HOOD i <br />WATER HEATEF . _ <br />WOODSTOVE <br />METAL FiREPLA( <br />FIREPLACEINSE <br />GAS FIREPLACE <br />FAN <br />SUB TOTAL 5 <br />PERMIT 5 <br />� � TOTAL FEE 5 <br />r�nn a�ecK Nuuoen / I F« �� <br />i / i „��. i ��) � <br />BUILOING � G} n� � /r'� e� ��=� � <br />y � 1`LUMDING <br />In � oYES �e�+� <br />M[CHA4�f.AL <br />RDOIilON4l PIAN CHEGN <br />OTHER <br />SiAIE BUILOINC SURGHARGE � � � � % <br />CITY OF EVERETT �ueucwonKs <br />LOCAL SALES <br />TAX CODE IS 3105 TO7AL <br />:? <br />