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APPLICAT14.�1 �OR CONSTRUCT.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STAEET • EVERETf, WA 98201 • 259•8810 <br />❑ DEMOLITION �I COMBINATION Cl BUILDING 3(I MECHANICAL f 1 PLUMBING fl SIGN <br />PROJECT ADDRESS <br />OWNEP MAILAODRE55 Cltt 21P PHONE <br />EiPW��✓ �v�,•3u7f1Y G7�G f/isNLHNO [iR t�E7CETT 98aZ�� oi'��-/�Ss <br />TENANT MAIL�ODRESS CITV 21P f'HONE <br />ARCHRECTORDESIGNER 61FILAD�RE55 Gltt ZIP PMONE <br />GENERPLCONTRRCTOR MAILAD�PESS GITv ZIP PNONF STATELICENSEr <br />MECHANICALCONIFAOiCR MRILAODRESS CITY ZIP PHONE STATEULENSE� <br />SE// <br />PLUMBIN� CONTRACTOR MAII AODRESS CITY ZIP PHONE STATE l ICENSE r <br />�s�o•o v <br />DESCHIBE WORK AND S�UFRE FOOTRGE INVOLVED <br />LEQ�L OE°CRIPTION OF PROPERTY <br />LOi BLOCN _ <br />PRRCELTA%LD.NUMBER <br />OR ATfPCH TWO <br />CONSTAUCTION LOAN LENOER, ADDRE55, iELEPHONE NVMBER <br />PLUMBIN6 <br />NO. TYPE OF flICTURE OR ITEM <br />WATER CLOSET (TOILET) <br />DATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAI <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />FOR OFFICE USE ONLY: <br />FRONTSETBRCK REPFSEiBACK <br />USE20NE <br />HEIGIIT UMITATION <br />OCGUPANCY NO.OF <br />GROUP <br />FIfiE AURM REO'U <br />LOi AREA <br />HEATING SYSTEM: N(GAS ❑ EI.EI:TRIC ❑ <br />GONTACTPEPSONPNpPMONENO. , <br />-/ %Y"d3 /� <br />I HEREBY CERTiFV 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 TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTN7RITV TO VIOLATE OR CANCcL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <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 AD!D I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />%���.c �....�_� 6 — / 9 —9a- <br />X DATE <br />$IGNFTYRE <br />oa �i�i <br />CITV BUSINESS IICENEE N0. <br />FE� N0. TVPE OF FlXTURE OR ITEM FEE <br />� A/C-A/HNDLGUNITS-H.P. <br />� FORCED AIR SYSTEM3 - B.T.U. M E.A. <br />, HEAT PUMP <br />� UNIT HEATERS - B.T.U. M <br />! CLOTHES DRYERS <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE $ <br />SIOE SETBACN <br />NO OFOWELLING <br />UNITS <br />DATE <br />VAChNi SITE <br />IIYES ❑ NO <br />SIIE OF BLOGR I. <br />❑YES C7 NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />RANGEHOOD <br />1NATER HEATER <br />WOOD STOVE <br />METAL FIREPIHCE ( <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />FAN <br />SUB TOTAL 3 <br />PERMIT 5 <br />TOTAL FEE 5 <br />PlANC11ECIf�I1�l0E(i�� FEE IRECEIPTNO. <br />BUILDING <br />PLUMAING <br />MECM�NICAL <br />ADOITIONAL PIAN C��ECK <br />otHEn <br />SiATE BIIILOING SUPCNARGE <br />ruoucwonKs _ <br />TOTAL <br />