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APPLICATIG.� FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. WA 98201 • 259-8810 <br />fJ DEAIIOLITION fi�. COMBINATION Cl BUILDING O MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS <br />E <br />C <br />�rati� �� <br />21P <br />C! J <br />PHONE <br />3Ss ' `/ <br />i r� w� � - <br />GENEMICONTR� OR MAILADDRE55 LIiY ZIP PNONE STA <br />T�r � mGfl'77`'r� <br />MECHANICALCON7RACTOR MMLADORE55 CITV ZIP PHONE STATELICENSE� <br />,�iPi�Yb /1s m urs? �/�- <br />PLUMlMKi CONTR�CTOR MAILPUDRESS Cltt 21P PHONE STATE UCENSE � <br />�./�Lr_ ifs .n ursfE/'— <br />�/l�.y(% f�v/I'f/ • T�GF.IS.VE/. • . <br />�eae ss ���`' �i,tsi <br />S�DrUSF�QF BUIIGING <br />. K <br />�o�i oescaivnar+ oF raocean �sNoww e�ow on <br />LOT � BLOCK �— <br />pMCEL TNt I.D. MIMBER <br />Np. TYPE OF Fl%TURE OR ITEM <br />el WATER CLOSET (TOILEn <br />BATHTUB <br />�'� LAVATORY (WASH BASIN) <br />/ SHOWER <br />KITCHEN SINK d DISP <br />/ DISHWASHER <br />LAUNDRYTHAY <br />� CLOTHES WASMER <br />� URINAL <br />ORINKINO FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL 8 <br />PERMIT S <br />TOTAI FEE 5 <br />FOR OFFICE USE ONLY: <br />. . a pqpl� $E7BACN � REAR SETB�CIS <br />w zo <br />USEZON LOTAREA <br />�-/ '7°�� <br />I MEIOHTIIMITATON � NOOFDWEW'16 <br />. � _. UNITS , <br />� <br />FlRE <br />FEh <br />SiDE SETB�GK <br />HEATING SYSTEM: ❑ GAS � ELECTRIC ❑ <br />CONTACT PERSON AND P E NO. <br />/„�! c /a,�/i� -lAL raC:�'-.1 <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 GOVERNIN6 THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTIN6 OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW RE6ULATIN6 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 AND I COMPLY WITH THE STATE <br />CONTRACTOQS UW 1827 RCW AND 296200 WAC. <br />�'�aa y�S"G _.._ <br />CIIY BUSINE55 UCE E NO. <br />Np, TYPE OF fll(TURE OR ITEM <br />A/C — AMNDLO UNITS — H.P. <br />�ORCED AIR SYSTEMS — B.T.U. M E.A. <br />HEAT PUM° <br />,� UNIT HEATERS — B.T.U. M <br />/ CLOTHES DRYERS <br />VENTILATION FAN <br />—T HANGE HOOD _ <br />PUN <br />METAL FIREPLACE ( <br />FIREPIACE INSERT <br />OAS FIREPLACE <br />OAS RANGE <br />:ANT SITE --- <br />YES fl NO BUILUING <br />BLDCR� <br />i SE L1��1�.l4 �' p�UMBING <br />� GAtAVE <br />SEMENT -/ MECHANICAL <br />❑YES ��+u <br />AODIT70NAL PIAN CHECK <br />i <br />OTNER ' � ��IOj\ <br />STATE BUILDIN� SVRCH�RGE <br />CITY OF EVERETT FUBLIC WORKS <br />LOCAI SALES <br />TAX CODE IS 3105 70TAL <br />fEE <br />SUB TOTAL S i <br />PERMIT S � <br />TOTALFEE S ' <br />FEE RECEIPTNO. <br />\ / <br />VALUATION F E <br />56 3�s �/(� i ov <br />� <br />L�'�iv� <br />�n_ ;nC? <br />