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APPLICATIOrI FOR CONSTRUCT�ON PERMIT <br />CITY OF EVERETT • BUIL�ING DIVISION �/ <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />yQ DEMOLITION ( l COMBINATION n BUILDING I� MECHANICAL � 1 PLUMBING f I SIGN <br />PROJECT ADDRESS <br />3829 HOY'P AVFNUE. EVERLIT� WA <br />OW4ER MnILADDRE55 GITY ZIP PNONE <br />EVERETP Q.INZC 3901 BOY'P AVE. EVQ2EIT 98201 33�5460 <br />1ENANT MAILRDORF.55 QTY 7:➢ p'110NE <br />�CNITFCT OR pf.51G1iFP <br />lf1Vt1JJH lif ['�J� <br />��� <br />GENE{iAlWtlIRRG1Gq MAILADDRE55 ptY IIP [�nONE SIAT[IICFNSE� <br />K��1'�ESC—aDLE ASSOCIATFS. INC. P.O. BOX 1179� SNOE�pMISO, 98291 (31� SG8-3175 RiuT�rn77� <br />MELN/.NICAL CONTR4CTOR NAI� ppORF.55 CITV liP prlpNE STATE LICF.NSE � <br />PLUMBINGWN7PPCTOP MqILnDDRESS LIrY ZIP PI�ONE STATELIGENSE• <br />CONiRPCi PRICE OF WORK <br />OESCRIBE WORH AN� SOUPPE FOOTAGF. INVOLVED <br />OF <br />LEGAL DESGRIPTION Oi PROPEPTV (SMOWN BELOW OR AifPCH MO <br />tOi BLOCK� OF <br />�S � % C /�3-7� /ll-' <br />PARCEL <br />GONSIRULTIONLOANLENOER.ADORESS.7ElEPHONE NOMtlER <br />PLUMBING <br />NO. TYPE OF <br />WATER CLOSET I <br />BATHTUB <br />LAVATORV (WASF <br />SHOWER <br />KITCHEN SINK 8 <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />HEATING SYSTEM: I I GAS �l ELECTRIC f l <br />CONT4Ci PEf150N I.ND PNONE NO <br />I HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED THIS <br />AP?LICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND I)RDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED'NITH WHETHER SPECIFIED HEREI�1 OR <br />NdT. THE GRFNTING OF A PERMIT DOES NOT PqESUME TO GIVE <br />AUTHORITY TO VIOLATE C1R CANCEL THE PROVISION OF ANY <br />O7HER STATE OR LOCAL LA�V REGULATIN6 CONSTRUCTION OR ThIE <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 F�ND I COMPLV WITH THE STATE <br />CO!JTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />����� i/�%$ <br />SIGNAiURE DAi[ <br />GIiY BUSWE55 LIGENSE N0. <br />MECHANICAL <br />Oq ITEM FEE NO. TYPE OP EOUYPMENT <br />A/C — AMNDLG UNRS -- H.P. <br />� FORCED AIR SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />' UNIT HEATERS — B.T.U. M <br />i CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOCD <br />WATER HEATER <br />WOODSTOVE <br />i METAL FIREPLACE (WOOD BURNING) <br />� FIFEPLACE INSERT (WOOD BUFNING) <br />i GAS FIREPLACE <br />��) GASiiANGE <br />; GAS PIPING <br />SUBTOTAL SI <br />PEFMIT 5 � <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />fPONTSeTpACM p[�q SFTBACK S�DE SETPRCK <br />U'iF20NB �pfRREA VAC�Ni51if <br />fIY[< I1 NO <br />MEIGIIiLIMITRTION NOOfUWlILING SIIEOfBt[HMI <br />UNILS <br />IX:GIIPANCY I N0 pf SfOnqS OCCUPANL LOAO <br />ci�n��r <br />FIRE ALARU R[O'[1 Pf A504 <br />FIRF$PRiNNIF.PRFOD RF�SON <br />IYPf O� fONCI PI �N$ APPnpyFp pY <br />.—..- --�,,vi---- <br />(IYES �1 NO <br />NUMOFR <br />OUIIDING <br />PIUMpING <br />MFCIIANICqI <br />�OD�llpN�L PIAN CIIF.CN <br />OTMEq <br />STA1E BUIIDING SUNCMAqGE <br />CITYOFEVERETT rnniicw�nKs <br />LOCALSALES <br />TAX C�JDE IS 3105 _70TAL _ <br />�Ef <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />RGf.EIPT NO <br />FEE <br />