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APPLICATIt�A FOFi CAN�TRUCT�ON PERMIT/ <br />CITY OF EVEREiT • BUILDING DIVISION eC� <br />3200 CFDAR STAEET • EVERETT, WA 98201 • 259-8610 � <br />fl DEMOLITION fl COMBINATION n BUILDING �, MECHAMCAL n pLIiMBING f l SIGN <br />PROJECT P.JDRESS 3 ` � � �� � � � v� � � <br />J�1\� vrVfT/ <br />TENANT <br />S ���1 � <br />PRCHITECi OR OESIGf1ER <br />MAIL qD�RE55 <br />MAIL ADpRE55 <br />r R� <br />Z�P pHONE <br />-P 9d zo 2-s �— <br />zir p�ior�e <br />11n PHONE <br />GENERPLCON'RpCtOR IAAILADDRESS CiIY DP PIIO4E STATELIC[NSE• <br />MECHANICALCONTRACTOfi MAILAODRE55 CITY ZIP PIIOGE �TAT t FNSE• <br />�P�,uHhobaa� <br />:o��aace 1���.�4��_ �`fal Noy� Rv .�� ����1'f' g�3� �-S"9-45/� _ <br />PL11M91NGCONTRAf,TOR MnILPODRE55 CITY ZIP PHONE SiFT[IICENSE� <br />I.VNIHPI:If'RI[:tOFWOAK V����_'�'� <br />•r <br />DESCR19E WORK ANO SOl/ARE FOOTAGE INVOtVED <br />� REPA�1c,� (�q,q <br />�A ��L !-�E R <br />LOT BLOCK <br />Of. <br />h� � <br />PARLFITAXID.NUMBER <br />CONSTqUCT10NLOFHIENDER.RODRES$ TEIEPHONE NOMIIER <br />PLUMBING <br />NO. TYPE OF FI%TURE OR ITEM <br />—rWATER CLOSET (TOILETI <br />LF�VATORV (WASH BA; <br />SHOWER <br />KITCHEN SINK 8 DISP <br />CLOTHES WASIiER <br />URINA! <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SINK �SERVICE — <br />PERMIT 5 <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />fRONT iFTFlACH RF.Afi SFTBAGN SIOE SE7Pr1CN <br />PSE ZONf: <br />11@IGNT LIMIiPiION <br />OCGUPANCY NO( <br />cnour <br />FlREAIARM REOP <br />fIRF SPRINKIFRFI <br />iYPF_ Of f.ONSt <br />FEE <br />HEATING SYSTEM: XGAS �1 ELECTRIC �l <br />CONTACT PERSOH n� PMONF NO � � <br />�9- �`//� <br />I HFREBY CERTIFY THFT I HAVF READ AND EXAMIIJED THIS <br />A��LICATION AND KNOW THE SPME TO DE TRUE P.lJD CORRECT ALL <br />PROVI�IONS OF LAWS AND GRDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIEO WIiH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUNE TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHFR STATE OR LOCAL LAW REGULATING CONSTRUCI�ION OR THE <br />PERFOHMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM I�ItiE WORK FOR Wf�IICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18:27 RCW AND 296.200 WAC. <br />�(� - �a �1 � 5,�_ <br />si �u uaG om� <br />CITV DUSING55 LI�ENSE N0. <br />MECHAN!CAL <br />NO. TYPE OF EOUIPMENT FEE <br />�— <br />A/C — A/HNDLG UNITS — Ii.P. <br />/ FORCED AIR SYSTEMS —[3.T.U./�� M E.A. ; <br />UNIT HEATERS — D T.U. Ni <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOJ BURNI <br />FIREPLACEINSERT(WOOD BUR� <br />GAS FIREPLACE <br />GASFANGE <br />GAS PIPING <br />EXHAUSTFAN <br />IOi AREP VACRNL SI�F hCCJ <br />I IYFS I! NO OUIlflMfi <br />NOOFpWF.L�iNG 512GO�OLOGRI <br />�����5 PI UMAING <br />OCCIIPANLLO/D �ASEMENi VfG1ANIC4l <br />uves �i�+o <br />RFASON �DDI110NM. PI AY GNF.C� <br />Oii�ER <br />FFA$pq <br />STi�I[ �U:I�MG SURCIIARG[ <br />❑inNsarrnovennr CITYOFEVERETT runnr,wonKs <br />LOCALSALES — <br />r�tE, TAX CODE IS 3105 TOTAL <br />SUBTOTAL S U; <br />PERMIT 5 � <br />T0T.4L FEE S %�; — <br />r�r I nEceirrno <br />FEE <br />