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APPLICATIO.� FOR CONSTRUCT.JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION fl COMBINATION Cl BUILDING YS MECHANICAL f] PIUMBING Cl SKiN <br /> PROJECT ADDRESS nO,,r�y � ,/_,� ���� <br /> �s i� �y-�c <br /> �i,� �ur���E��4 C�N� Al� E��.F�t zqsao► as� -��,� <br /> ��Jl�*,YM1.�I�f�i,�oness /3oZlYF��1� m�W-IW/ ziP �J /�.3�� <br /> M <br /> 11qCHR�ECTOROESICaNER MAILAD�� 55 LITY IIP PHONE <br /> OENEA�1lCONTRACTdi MAIIADpiE55 CITV 21P PMONE ST�TEl10EN5E� <br /> MEq1ANIC/�.�Ly`CONTRACTOR MAILADDRESS CITY ZIP PNONE STATELICENSE• <br /> PLVMlRN3�CTOR MMLADDilE55 qTY ZIP PMONE STREUCENSEI <br /> CONTMCT OF WORI( <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> pE$CRIlEWp{IR�NDSOU�REFOOT NVOWED CONiA,^.iPER50N�NDPMONENO. � <br /> I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> p ��Lp� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES 60VERNINO THIS TYPE OF � <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> IEpµpEgCRIPT10NpFMiOPERTY�5110WNeELOWOilATP1CNiWOCOPIE51 NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br /> ioT e�ocu_ oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL UW REODUTINO CONSTRUCTION OR TME <br /> PERFORMANCE OF C RUCTION.THAT I AM AUTHORIZED BY TME <br /> OWNER OF THIS PER 1'O PERFORM TME WORK FOR WMICH <br /> APPLIC N MADE AND I COMPLY WITH THE STATE <br /> PMCELTA%I.D.MIMBER CONT O 1B. RCW AND 296200 WAC. <br /> ' �7 � 9S <br /> CpNS1RlICTIp1 LOAN LENDER,ADDAESS,IELEVHONE NUMBEP . <br /> 516 D� <br /> CI BUS�NE IICENSE NO. <br /> p��Np MECNANICAL <br /> N0. TYPE OF FlIfTURE OR ITEM FEE NO. TVPE OF FlXTUHE OR ITEM FEE <br /> , WATER CLOSET(TOILEI') � /VC—MHNDLQ UNITS—H.P. � <br /> g�T►{T�B � FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> � SHOWER � UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> ' IAUNORY TRAY ; RAN6E HO00 i <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> � DRINKINO FOUNTAIN i METAL FIREPLACE(WOOD BURNIN6) i <br /> FLOOR DRAIN � FIREPUCE INSERT(WOOD BURNINO) � <br /> BACKFLOW PREVENTERS ; OAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � OAS RANOE ' <br /> � OAS PIPINO ' <br /> i EXHAUST FAN � <br /> � ' <br /> � � <br /> i ' <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S ' <br /> PERMIT S i PERMIT S � <br /> TOTALFEE S ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FROMSE7HACK REARSEiB�CK SIDESETB�CN PUNCHE K UMBER i'EE AECEIPTNO. <br /> � <br /> USE ZONE LOT�REA WCANT$ITE FEES VALUATON �E <br /> fIYES ❑ NO BUILDING � <br /> MEIOHT LIMITATION NO OF OWELLJN6 SIZE OF BLOGR.I. � <br /> UNITS PLUMBING � <br /> �UP�NCY NO.O�STOPoES OCCUPANTLO�D B�SEMENT MECMANICQ <br /> ❑YES ❑ NO � <br /> FlREAURMREO'0 REASON AWITION�LPLANCHECK I <br /> OTMER � <br /> FlRE SPXINKLER REOU REASON ' <br /> STQE BWLDING SURCHARGE i <br /> iYPE OF CONSi PUNS A ROVED BY � <br /> � CRY OF EVEREI'T 7UBUC WORKS , <br /> LOCAL SALES � <br /> DATE � o '� TAX CODE IS 3105 TOTAL � <br />