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APPLICATIl.�I FOR CONSTRUCI.ON PE�iMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION Ci COMBINATION F} BUILDINCi ❑ MECHANICAL f3 PLUMBINO fl SION <br />APCHI7ECTOFDESIGNER MI11lADDRESS � CITY ZIP PHONE <br />- — - � �� d__. Zaer �.�\_�Q7�z 43� CO'�i <br />�in. Zi� PIIONE <br />CHIWIGILCONTRACiOR MNLADDRE55 ` CITV ZIP PHOVE STATELICEFSE� <br />p����ryp�Tp/�Tpq MMLIIWRESS <br />CITV ZIP PH(1NE ST�TELICENSE� <br />ra� aF vromc <br />WOi1K �ND ��TAGF "1VOLVEU <br />��.n � . n <br />LOT �`� "^ HIu:R <br />Pdt'�C �•v Z <br />� ��2 �17�iJ, S <br />PAi10EL TA%I.D. MIMBER <br />CONSTRUCTION LOMI LENOER. �DORESS. TELEPIIONE NUMBER <br />�V�d <br />Np, TYpE OF FlXTURE OR ITEM <br />Z WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />I� DISHWASMER <br />\ UUNDRV TRAV <br />\ CLOTHES WASHER <br />URINM. <br />DRINKIN6 FOUNTAIN <br />ROOR DRAIN <br />BAq(FLOW PREVENTERS <br />SINK (SERVICE — BAR. ETC.) <br />J.� I HEATING SYSTEM: C GAS Oi ELECTRIC ❑ <br />�/� n� rCONT�CT PERSON ANO PNONE N0. <br />�— I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES OOVERNIN(i THIS TYPE OF <br />WORK WILL BE CAMPLIED WITH WHETHER SPECIFlED HEREIN OR <br />Hocoaies� NOT. THE ORANTIN(i OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OH CANCEL THE PROVISION OF PNY <br />OTHER STATE OR LOCAL LAW REODUITINO CONSTRUCTION OR 7HE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STA-E <br />CONTRACTORS LAW 1827 RCW AND 298200 WAC. <br />SUB TOTAL S <br />PERMIT S <br />70TALFEE S <br />FOR OFFlCE USE ONLY: <br />ipONTSE7gACK _ / RE�RSEi9ACK_ I <br />fiG/s <br />l�C�� <br />USE ZOPIE I LOT AREA <br />� � <br />HEI�HT��A� / �IT�DWEWNG <br />� �� <br />-- _ . .:.��_.� ��-z.�.-9y <br />x � o�re <br />SIONATURE <br />CIiV BUSINESS LICENSE N0. <br />N0. TYPE OF FlXTURE OR ITEM <br />/UC —qMNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATEP,S — B.T.U. M <br />CLOTHES GRYERS <br />VENTMTION FAN <br />RANGE Fi00D <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT (WOOD BURNINO) <br />OAS FIREPLACE <br />OAS RAN(iE <br />�AS PIPIN(i <br />EXHAUSTFAN <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />PLANCNECKNU/D � () I FE�JC� RE( <br />V�C�NT SITE �� <br />❑VES ❑ � BUILDING <br />� g�pp/f.l <br />SFi�4 S 4q PLUMBINQ <br />BASEMENT MECHAN�CAL <br />❑YES � AOO�nON�LPLMICNECK <br />OTNER dy' <br />SiA7E BUIIDING SURCN�i1GE <br />CITY OF EVERETT PUBLIC WORKS <br />ILOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />�? <br />// <br />