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APPLICATION FOR CONSTRUCT�OI� P�RMIT�w�� <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />- n <br />I-1 DEMOLITION i l COMBINATION r BUILDING � MECF:ANICAL PLUMBING SIGN <br />PROJECTADDRESS �0�� 'f�D � <br />,� <br />OWNER MAiLPDDRE55 CITY ZIP PIIO'lE <br />'Saln� �-1� .�l 2�c �[ � �� i n �" s+� �! W�1�s�(:\t�qg i.� o C �-z z�l-� �j <br />TENANT � UAiIADC�F.55 QTY 71P CHOryE <br />ARCHIiECT OR OES�GNEH MRII ADDRESS CIiV II� PMONE <br />v� �_ <br />MECNAkIC/ L CON: FFC i OR <br />PWR, :NGCONiRAf,T(Si <br />GONTRIQ �qICE OF WORK <br />DESCRiBE YJOPN pND SOU�� <br />�ecni oescmm�orror raore <br />LOT BLOCK <br />!/AIl <br />Nalt ADDPESS <br />f00TnGE <br />oF <br />LONSTRUCTIONIOANlENOER.A0DRE55.TElEPNONE NUMBER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />L.IVATORY (WASH BASIN) <br />K�TCHEN SINK 8 DISP <br />TRAV <br />WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREI'ENTERS <br />SINK (SFRVICE — �AFi. ETC. <br />SUB TOTAL S <br />PERMiT 5 <br />TOTALFEE 5 <br />FOR OFFICE USE OhLY: <br />fli0Ni5FTP/.CN P[MSFTARCK SIOF.S[TPACk <br />USE IONf <br />IIEIGIR LIMITATION <br />OCCl1PANCV NO Of 9p�iiFS <br />GROOP — <br />fIRE eURM PEO � <br />f IRF SPRINNI f R PF.O D <br />i rr� ar cor+sr <br />CIiY <br />fEE <br />S1ATE IICENSE � <br />ZIF P110NE STATE ULENSE � <br />ZIP PHONE $TATE UCENSE � <br />HEATING SYSTEM: i� GAS � ELECTRIC � 1 <br />CONiACT i'ERSG4 AND PIIONF NO <br />I HEREBY CERTIFV THAT I HAVE REA� AND EXAMINED THIS <br />APPLIJATION ANO KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVI-E OF <br />WORK WILL BE COMPLIED WITH WHETHER �PECIFIEfI I�EREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO ': �OLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LJCAL LNW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONS7RUCTION. THAT I AM AUTHORIZ'cD 3V THE <br />OWNER OF THIS PROFcRTY TO PERFOR�A THE WORH FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTOR� LAW 1827 RCW AND 296.200 WAC. <br />x e�.U---_ l'aa - � ;� _ <br />SI.NA1 IRr Da1F. <br />CI1Y OUSME55 LICENSC NO <br />MECHANICAL _ <br />NO. TYPE OF EQUIPMENT FEE <br />A/C — A/HNDLG UNITS — H.P. � <br />FORCED AIR SYSTEMS — B.T.U. M E.A. ; <br />--� <br />HEATfUMP <br />UNITHEATERS—B.T.U. M <br />�LOTHES DRVEFS � <br />VENTILATION FAN <br />Fl?NGEHOOD � <br />WATER HEATER <br />WOOD STOVE i _ <br />METAL FIREPLACE (WOOD BURNING) � <br />PIPEPLACE INSERT (WOOU BURNWG) <br />GAS FIREPLACE � <br />--� <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />—�-- <br />SUBTOTAL ff <br />PERMIT 5 � <br />TOTAL FEE S � <br />r�nr�cuecnr�uMnrn / ��« Inrceirrr�o <br />IOf �REA `/ACRqt 51![ YCCJ <br />11Yf5 �'�!!O pplL[llNG <br />NOOfI�WFLLING SZEO�BIOGRI <br />UNIIS PLIIMflING <br />OCCUPANiL04D BASEMENi MFCIIANICAL <br />IIYES li NO <br />FIIDIIIONAL PUN CIII:GN <br />RE\50Y <br />O1HER <br />fiFASON <br />�LNE BUI�DI4G SII�f,H110GE <br />vinNsnrr�oveoav CITYOFEVERETT ����r+ncwo�Ks <br />LOCALSALES <br />�,;,�i TAX CODE IS 3105 707AL __ _ <br />