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APPL��AT�iO.rl FOR CONSTRUCTIVI� RERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />' 3200 CEDAR STREET • EVERETT, VVA 98201 • 259-8810 � <br />fl DEMOLI�ION fl COMBINATION bQ BUILDING fl MECHANICAL f� PLUMBING fl SIGN <br />TeNnr+r - � Mnitnooness cirv zi> rHar+E <br />ARGHIT OROESIGNER MPIIFOpRE55 Cltt ZIP P��ONE <br />� f�l1�L•l� <br />�{�+s�AICONi CiOR �q+ AI�ApOnE55 CITV ZiP - PIION[ SiATELILENSE� <br />fit�i• �fY��`t' I�?4��1t�F� �f Ct' I�i �A��'�S l�� I17� t�.��Fc���,� 22(1.-57�� <br />CONiR�CiOR MAIIADOPE55 <br />CONTRFCT <br />GILY <br />LEGAL�DE' fll IONOF?ROPERtt�y10WNBElOWORATTaG�H,T�Y° GOPIES) <br />LOi � � ' ' � OIOCl: � oF -�/ � � q�. <br />I"l �+� i�Q� � IQ ���[L�v1�F� � <br />1 <br />PARCElTAX1.�.NUM�EP O <br />��(,?/��/5����% � -�tr'�! <br />GONSTFIICTION lOAN LENOER. �DOfiE55. TEIEPMONE NUM�E(i <br />NO. TYPE OF FI%TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLONIpREVENTERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />fRONTSET�ACK REARSFTOf.CK <br />USE20NE LOLAf1E4 <br />f <br />MEIGMTLIMITATION NUO�DWELLING <br />UNlig <br />OCCUPANCY NO O�SIOaiES OCCUPANTlO�D <br />ov r,ensr r�nNs <br />unTE <br />FEE <br />SIDE SETBnCN <br />VRGA�lI cliE <br />IYES f' NO <br />Pu@:E <br />� <br />ZIP PNONE STATE UCENSE � <br />HEATING SYSTEM: f..l GAS rl ELECTRIC f� <br />COiJTAC � PERSON ANO PIIONE NO. <br />I HERB�Y CLRTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TFUE AND COPRECT. ALL <br />PROVISIONS OF �_AWS AND ORDINANCES GOVERNING THIS TYPE O� <br />WORK WILL BE COMf'LIED WITH WHETHER �PECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING COtJSTRUCTION OR THE <br />PERFORMANCE OF C(�NSTRUCTION. THAT I AM AUTHORIZED BY THc <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLIC.�TION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />X('� , X.Q.e p� l�yu �, .2" S=/�� <br />SIGYnTIIRE � OnTE <br />p�Y 9USME55 LICENSE NO <br />MECHANICAL <br />NO, TYPE OF EOUIPMENT FEE <br />A/C — A/HND! G UNITS — H.P. : <br />FORCED AIR S��'STEMS — B.T.U. M E.A. � <br />HEA7 PUMP � <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS i <br />VFNTILATION FAN ' <br />RANGEHOOD ' <br />WATER HEATER � <br />WOOD STOVE <br />METALFIREPLACE(WOOD BURNING) i <br />FIREPLACE INSERT (WOOD BURNINfi) ; <br />GF.S FIFEPLACE � <br />GAS RANGE ' <br />GAS PIPING � <br />EKHAUSTFAN � <br />SUB TOTAL 5 <br />PEFMIT S <br />TOTAL �EE 5 <br />ninN cr�ecK r+un+or:n � rEE � necEirr ruo. <br />� ' ouunmc <br />S�LE OF BIDGRI <br />PLIIMOMC <br />BASE�dENi MECH4NICAl <br />IIYES fl NO <br />— ApD�iIONAI.PIANC��F.CN <br />Oi11ER <br />STN[ OUILDM6 SIIfiCMARGE <br />CITY OF EVERETT' rnmir,wonHs <br />LOrALSALES <br />TAX COD[ IS 3105 70TAL <br />