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APPLICATiI�:� FOR CONSTRUCi _aN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION Cl BUILDINQ � MECHANICAL Cl PLUMBINa ❑ 810N <br />PRWECTADDRESS \ � '� 'a,,� (��s �V�Y� �.1� ���) <br />\ <br />OYMER MRILADDRE55 CITY ZIP PHONE <br />-�Z. c' ��.r�__�. �Q�..,�' 1 �-_ � ..,-i� �c �•., t �Ca ,.�1nC <br />}�M �V MAILADDRE55 v CItV ZIP vnunt <br />� <br />11RLIfiIECTORUESIGNER MNLMORE55 CI7Y 21P � PNONE <br />OENER�LCONiW1CTOR MAILADORESS CITY 21P PIIONE S1�TELICENSEI <br />MECH�MCALCONiP�CTOR MAIL�DDRESS CIiY 21P PHONE STATELICENSE� <br />b WY��t' �`� <br />MUMRMOCONiRACiOR M�IL�DDNESS CITY ZIP PHONE STATELICENSE� <br />DE9CIME WOIIK AND SOUME FOOTA6E INVOLVED <br />ior <br />� <br />S F 1"� <br />,�MPIION OF PIIOPEAfY ISHONM SELOW OR �TfACH TVYO COPIE5) <br />e�oac oF <br />f I.D. MAIlER <br />TION LWN lENOER. ADORESS. TELER10t1E NUMlER <br />� <br />TYpE OF FlIfTURE OR ITEM <br />WATER CIOSET (TOILEn <br />BATIiTUB <br />LAVATORV (WASH BASIN) <br />SHOWER <br />KRCHEN SINK 8 DISP <br />OIBHWASHER <br />LAUNppV TpAY <br />CLOTHE& WASHER <br />URINAL <br />ppINKRq FOUNTAIN <br />ROOR DRNN <br />BAq(FLOW PREVENTERS <br />SINK (3ERVICE — BAR, ETC.) <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />F110NTSEiBACK REM! <br />USEZONE <br />�Kurt ur,«r�nor+ <br />LOT�REA <br />ra. oF owewr+c <br />uNirs <br />HEATING SYSTEM: ❑ QAS ❑ ELECTRIC ❑ <br />CONTACi PERSON �NO PHONE NO. <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />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 Wlhl WHETHER SPECIFlED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTNER STATE OR LOCAL LAW REdULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOH NRMCFI <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 298200 WAC. <br />z �'� -��► <br />$Nyf;n�� DATE <br />C <br />CIT' BUSINEfS LICENSE NO. <br />FEE NO. TVPE OF Fll(TURE OR ITEM � <br />, A/C — AIHNDLO UNITS — H.P. <br />� FORCED AIR SYSTEMS — B.T.U. M E.A. <br />, HEAT PUMP <br />� 11NITHEATERS—B.T.U. M _ <br />SIDE SETB�CK <br />VACANT $ITE <br />❑res n r+o <br />512E OF BlD6lf I. <br />C! YES ❑ N� <br />cin oF eveRErr <br />IOCAL SALES <br />TAX CODE IS 3105 <br />CLOTHES <br />FAN <br />WATER HEATER <br />WOOD STOVE <br />METAL FlREPLA( <br />FIREPLACE INSE <br />(iAS FlREPLACE <br />OAS RANOE <br />OAS PIPINO <br />EXHAUSTFAN <br />SUB <br />Fj <br />PLAN CHECK NU�IBER �� I FEE I���T �' <br />BUILDING <br />PLUMBING <br />MECMI�MG/LL <br />ADDITIOH�L PLAN CNECK <br />OTHER <br />STATE BUILO�NO SURCHARGE <br />PUBLIC WOpKS <br />TOTAL <br />