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APIPLICATlON FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STAEET • EVERETT, WA 98201 • 259-8810 � <br />i 1 DE �UTiON i�,COMBINATION f-1 BUILDING I I MECHANICAL i', PLUMBING r, SIGN <br />PROJECT AnDRESS <br />��� �/U-e�sT %�-eiPG % %�y <br />oviv�n rn,vi nonuess arv <br />!1'l..EE f�i..�.vx �a�ToX,..aa�� �' ��r a �"�N: __ . _ <br />.�,_ s.,c_ no..., y _ <br />ldAIL AOpRE55 <br />W i uti• <br />NAIL ApppE55 <br />MAIL <br />CONTRACT PR�CE OF WpRK <br />OF RIBE WORK ANO yUARE FOOT�GE INVC <br />//I/ �iE %�/%�%J�� <br />2w �`v�s J`w <br />�'HUv�q}1,�E OF BUILOING <br />d K <br />LEGAL DES�CRIPTIOj�N OF PROPERTY �5 WN fiEIOW OR <br />LOT _�9J 7 ALOCN � Op_ <br />.� �7 J'7`i9�efi� � <br />PARCEL A%ID NUM�FR <br />Br �/I-7` � �3-f <br />COr�' "a�R�CJION IOAk ! j�JDEF. A�aR�55. TELEPHONE � <br />NO. TYPE OF FIXTURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />Sti�WER <br />KITCHEN SINK 8 �ISP <br />DISHWASiiER <br />LAU�DRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SEFiVICF — aaa Frc � <br />uir <br />a y� <br />�Pi� ✓ / <br />CITV <br />CIiY <br />CIN <br />N <br />7�P PMpNE STATE LICENSE � <br />ZIP PHONE $TATE LIGENSE � <br />L%I HEATING SYSTEM: I I GAS �ELECTR!C I-1 <br />LOYTf Ci PER504 pN0 PHONr. q0. <br />/L��%G� n� /_i/�. �� .�i.4�1%' �J'�� ./ <br />SUB TOTAL S <br />PERMIT S <br />TOTAi. FEE S <br />FOR OFFICE USE ONLY: <br />FRONTS)ET�PAGK REAqSETMC� <br />C..[.l / <br />USE20N� — I LOTAREb <br />— - �Z� <br />MEIGNT LIA4TATION � NO.OF DWftLING <br />� UNITS I <br />OCCUPANCY Np pPSiCR:ES OCCIIPANiL0�0 <br />GqOUP <br />—," I DAT[ <br />,(,/ " 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK N/ILL BE COMPLIED WITH WHETHER SPECIFIED HeREIN OR <br />COPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL iHE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFURMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WyICH <br />�O/'� /N -S APPLICATION IS �AADE AND I COMPLY WITH THE ST�TE <br />��a CONTqACT RS LAW 1827 RCW AND 296.200 WAC. . <br />y/ 2 /� 003 � p� � <br />G�QA '�/lo � <br />�rATI S / OATE <br />Y <br />CITY pUSME55 UCENSE N0. <br />MECHANICAL <br />FEE NO. TYPE OF FI%TURE OR ITEM FEE <br />� A/C—A/HNDLGUNITS—H.P. i <br />_�_ FORCED AIR SYSTEMS — B.T.U. M E.A. � <br />� HEAT PUMP —� <br />i <br />' UNITHEATERS—B.T.U. M ~— <br />i CLOTHES DRYERS � <br />VENTILATION FAN � <br />RANGEHOOD � — <br />� WATER HEATER - —� <br />� <br />' WOOD STOVE i <br />� METAL FIREPLACE (WOOD BURNWG) <br />—�— <br />FIREPLACE INSERT �WOOD BURNING) � <br />I GAS FIREPLACE � <br />—r � <br />GAS fiANGE <br />. ; GAS PIPING <br />i ExHAUSTFAN � <br />SIOE SET9F�K PLAN GHECN NUMOF.R <br />V�CANTSIiE � '-� <br />�Es n No <br />ouaomc <br />)F BLDGrtI <br />y 5_F. ��v�uc� { rwuoirvc <br />�o S.-. GiPRPGG <br />��SEldENT MECHANILP: <br />f1YE5 f`'d0 <br />AD�ITIONAL PLFN CHECK <br />OTHE9 <br />STATE �t11LDIHG SIIRCMARGE <br />CITY OF EVERETT auoucwonKs <br />LOCAL SALES <br />TAX CODE IS 3705 70TAL <br />SUB TOTAL S � <br />FERMIT S i <br />TOTAL FEE S � <br />FEE RECEIPTNO. <br />�'2 � � �//O7 <br />VALUATION FEE <br />—�-- <br />�J �28 j O�� I��"; <br />�L - <br />� <br />_ /'.> i.��., <br />�/ � � i /J O <br />