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APPLICATION FOR CONSTRUCAON PERMIT <br />CITY OF EVERETT A BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT, WA 98201 R (425) 257-8810 <br />X DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />rtNANr uMI. AODREss 0" ZIP PNCNE <br />AR UCT On OESICNER MNIAOD-ESS Cm nP PNONF <br />GENEML CONrMCTOn -MAIL ADORE SS Wy ZIP PIgNE StATI LICENSE. <br />PIUMBNG CONIRACIOR MAIL AbppESS CIN ZIP PNONE STATE LICENSE• <br />CgI1RAC1 ICC OL Mp16 <br />HEATING SYSTEM: O GAS ❑ ELECTRIC ❑ <br />CIE NORk ANO souApE TooTAG[PrvavtO <br />CONTACT PERSONAND PHONE NO <br />awe A7 3010 ('ae/� <br />' / L <br />FK�sE`usE BUNgNo �"' <br />APPLICATION CAB ON ANDFY THAT I HAVE KNOWTHE SAME TO BEAND TRUEAND CC EXAMINEDTHISPALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORN WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORI'. f 'f0 VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE NO I COMPLY WITH THE STATE <br />CONTRACTOR W 18, CW AND 296.200 WAC. <br />LEGAL 0ETC PTNM OF PMIPCRTV ISLgMN @ELM OR MACH END C@IE51 <br />LOT BLOCK Or <br />PARCC nl IO .USER <br />E. ri Oob 03--7 0002 <br />CONSTR xvIVV CAN LENBER.AIXIRESS, iCIFPNg1E NUMBER <br />scNA LE O 1 <br />CITY BUSINESS LCEWA NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C —A/HNOLG UNITS <br />BATHTUB Z <br />FORCEU AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />_ <br />FLOOR DRAIN <br />i <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GASRANGE <br />SINK (SERVICE -- BAR, ETC.) <br />GA: PIPING <br />EXHAUST FAN <br />SUBTOTAL S <br />SUBTOTAL f <br />_ <br />PERMIT S <br />PERMIT $ <br />TOTALFEE S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FADNTBFTRACK <br />RFArI Sr1RACk <br />SCESErBICk <br />MFN g1ECR NUMIITR <br />rfF <br />ArruPr NCI <br />2 <br />USE ZONT <br />IOt MICA <br />vACAYT NTE <br />FEES <br />VALUATION <br />FES <br />_ <br />Or[! ONO <br />BUIdM: <br />_ <br />_T_ <br />IIEIgIr 11MITArgN <br />NOO'MELLING <br />SIZE OF BLOGIII <br />milts n <br />�— <br />IIrvl15 <br />OCCNPAnLr <br />N]r451117s <br />IX:COPANI IUAU <br />E45EMEN' <br />! <br />GNOUP <br />MiMAN(:M <br />OYE9 NO <br />AODIAVAMMANONCK <br />j <br />rIp[sml:xuEn ptO'D <br />nfesw —' <br />olmn <br />IIREAIARMRED'D <br />RF ASGV <br />SIAI[ RIRIOAAI SMCNAW <br />IrPErcro•lcr <br />PtAxs Aft gVFUDr CITYOFEVERETT <br />nawrIm NS <br />LOCAL SALES <br />TOTAL <br />--1— <br />DAYE _ TAX CODE IS 3105 <br />