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APP��CATI�.�I FOR CONSiRUC7.O1V PERItA1T <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMQLITION fl COMBINATION �l BUILDING _� MECHANICAL rl PLUMBING ( I SIGN <br />PHOJECT AD�RESS <br />/9 /-/oy� �vF_ : v,',� <br />��ER MAI�p00PE55 <br />i cm zir� rrioNe <br />,EN���%7/LL i� £ ,.ra�z�a�,a S�.rr-� 9i �? .Uoy>.vd�, 9ezoi <br />MNLApORE55 CIiY jIP pHONE <br />MCNRECTOR�ESIGNER MAILp00RE55 CIiY <br />ZIP PMONE <br />GENEf1A� WNTR�LTOfI I.IAIIpDORESS CIIY 71p <br />PHONE St�T[ LICENSE • <br />IAECHANICRLCONTqACTOR MAqADORE55 ��T• Z�P <br />C� —� PIIONE ST�iE LICENSE • <br />PLIIMERJGCONTRAC70R MAILppDR'c55 �ITY ZIP PHONE — <br />SiATE LICENSE • <br />`18 6 q �= <br />UESCRIDE WORK ANp SOl1ARE FOOTAGE INV7LVEU <br />ior <br />L <br />BUIL7ING <br />+ cF raori <br />_ BLOCK <br />vqfiCEl TAX ID. NUMBER <br />CONSTRUCTION LOAN LENOER, AO�RE55. TELEPIIONE NUMBER <br />TYPE OF FI!RURE OR <br />WATER CLOSET (TOILEn <br />9ATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />OISHWASHER <br />LAUNCRYTRP.Y <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK(SERVICE—AAa Frr.� <br />FOR OFFICE USE ONLY: <br />fqONT SEIDACK REAR SFTUACK <br />USE ZONE <br />MEIGHT UMITATION <br />OF <br />HEATING SYSTEM: f jyGrAS rl ELECTRIC I l <br />CONtACT PERSON AN� Pf10NE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />- APPLICATIOIJ AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIfJ O.i <br />iwocoPiEs7 NOT. THE GRANTING OF A PE�IMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE 017 CANCEL THE PROVISION OF ANY <br />OTHER STATE OR L(1CAL LAW REGULATING CONSTRUCTION OR THE <br />_ PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFQRM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND'2�J6.200 WAC. <br />--- � -�v=9� <br />on.E <br />C17Y UOEINE55 LICENSE N0. <br />SUB TOTAL S <br />PERMIT y <br />TOTALFEE $ <br />N0. 7YPEOFEOUIPMENT FEE <br />A/C — AMNDLG UNRS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HE4TER <br />WOOD STOVE <br />ME7AL FIREPLACE <br />GAS FIREPLA( <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SIDESETBACN �nLANC1IECKNU1.lOf:R <br />lioranen vaen�irsrte FEES <br />nves r�� No oi�iio�r+c <br />NOOFUWELLING SIZEOFp�DGRI -- <br />UN17C <br />PLUMPING <br />OCCUPPNTLOAO BASEMENT <br />M[CIIr1NICAL <br />f1YES fl NO — <br />R'cASON AppI110N�1. PLpN CHf:CK <br />OTIIER <br />RFASON <br />SiAIE OUIlOING SURCH�pGE <br />v�nHsarrnoveoov CITYOFEVERETT ru�i.ir,wonKs <br />LOCALSALES <br />u�,rE TAX CODE IS 3105 TOTAL <br />SUBTOTAL $ <br />PERMIT S <br />TOTAL FEE $ <br />FEE _ _ � RECEIPT N0. <br />. _ .. _... . . . . . . _. . . . <br />... . ...... , - . . . . . <br />. ' , ��.�� - � � � � � � � - --.. . . . ... .. . .. <br />,. <br />��._"�._'.�._�_....:�:_ .. _ - —_ : . . .. . . . . .. .. . . . _ . _.._ _. : .. .. .. ._ ,. __... _... . _ __ . . . ..._ .. ____ . _ _._.__,_._ .. . .. . _ . : . <br />