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APPLICATIG.d FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STPEET • EVERETT, WA 98201 • 259-8810 <br />DEMOLITION ❑ COMBINATION ❑ BUILDING f-1 MECHANICAL rl PLUMBIN(i O SION <br />IOJECT ADDRESS �..5/ p / T� i�l9 C �iierL� �4. <br />Z�P 9&�0/- 4/as- asa - 38G� <br />�RCIRIECTORDESIONER M�ILADORESS CITY 21P PHONE <br />p���K.�({�}p/�(,'T(JR MNIAWRESS CITV ZIP PHONE STATELICENSEI <br />' CON71V1CTPiMCEOFMl011N <br />OEHCRIlE YYOIIK �HU 90UI1RE <br />. �F� } S � .t S�✓� � <br />� / ara <br />,, �� S�r� <br />� pqOpO�Eo OF2UlpN0 <br />I �o� oEsca�vfan oF rna� <br />i <br />I �ors� �' ��`xocu <br />INVOIVED <br />�ti; � b���� <br />a ��'t�ss asio , <br />0 <br />YN1LLl IM �. . Tlwiocn <br />s�s6- s�B - oal - o0 0 <br />CONBi11UC110N LQW LEIAER.110d1ESS. IElEP110NE MAREP <br />K�0 <br />N0. TYPE OF FlXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATIiTUB <br />IAVATOiiV (WA8H BASIN) <br />BFqWER <br />�I KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />' CLOTHES WA3HER _ <br />TOTAL <br />S <br />TOTAL FEE <br />FOR OFFICE USE ONLY: <br />F�� $��ry( REM SETBALK SIDE SElBFCK <br />[�F?�'-...� <br />f1E1011TUM1T11710N <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />WNTACi PERSON AND PHONE NO. <br />� HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br />f� PROVISIONS OF LAWS AND ORDINANCES OOVERNINO THIS TYPE OF <br />WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE aRANTIN(3 OF A PERMIT DOES NOT PRESUME TO OIVE <br />� AUTHORITY TO VIOLdTE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REOULATINO CONSTRUCTION OR TNE <br />PERFORMANCE Of CONSTRUCTION. THAT I AM AU7HORIZED BY THE <br />O\YNER OF THIS PROPERTY TO PERFORM iHE WORK WR WHICM <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 298200 WAC. � <br />,�,,, Cl.�,.,� a/�P/9s- <br />S�. �� �TE � <br />�......,.,,." / <br />CITV BUSINESS LICENSE NO. <br />►p, TYPE OF FlIITURE OR ITEM <br />A/C — AMNDLO UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CIOTHES DRYERS <br />VENTILATION FAN <br />RANOE FIOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FlREPUCE (WOOD BURNING) <br />FIREPLACE �NSERT (WOOD BURNINO) <br />OAS FIREPLACE <br />OAS RANOE <br />OAS PIPINO <br />E%HAUSTFAN <br />— SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />PUN CHE�K NUMBEP_ FEE RECEIPi NO. <br />IOTAREA VAC�NTSITE rcw <br />OVES ❑ � BW�DMO <br />NO.OFDWEWN(i SIZEO:BLOC✓fi. <br />UNITS p�UM81NG <br />OCCUPANTLO�O BASEAENT MECM�NICAL <br />❑ YES Il NO <br />AODITION�L MN CNECK <br />iIEASIXJ <br />OTHER <br />ilEA50N <br />STATE BUILDING SURCHARGE <br />PUNSMPPOVEDBY Cm OF EVERETT PUBIIC WONKS <br />LOCALSALES <br />� oA� TAX CODE IS 3105 TOTAL <br />