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�� � <br />APPLICATI4�! FOR CONSTRUC? �ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />fl DEMOLITION fl COMBINATION fl BUILDING MECHANICAL �l PLUMBING fl SIGN <br />PROJECT ADDRESS �� a O �� v�Q s�r �o� d �w'�� /�' Eu � re"� w� `� � � <br />�OMMER I /M��AIL�WRE55�y I CITY ZIP 1'1/0NC <br />aY c�Q $ O� �(�Y �C rTSSOf iCvl �' S <br />TENIINT MpILRD�RE55 dTY ZIP i'IIONE <br />h« ��- F�b,I�.�. ( <� <.sy��) <br />11RCNITECT pR pE51GNER M�II. A(�RE55 QTY 71P PNONF. <br />Igo.v �e s Stid�sfir;G( S vsf„., , Soo s.��.d�� .S..:tf�.e✓�4 98i3¢ �AKuHso�a e� <br />MECHRNICALCONTRACTOR M�ILRDDRE55 Gltt i.IP PIIONE $YRiEUCENSE• <br />PWMBINGCONiRRCt( ; M�IUDDRESS CI Ilo pHONE STAtEIICENSE� <br />T;.He 4- n�t r�a� - si'a�iat;'v.� o�. � ��ZciO� Ps �m�Q <br />CONTR�CT PRICE OP WORN <br />HEATING SYSTEM: f 1 GAS fl ELECTRlC (� <br />DESCRIB`E WORK ANO SpU�RE FOOT�GE INV WEO ' CONT�CT PI[ RND HpNF (� /�nJ <br />��nS1aI1 A hfW �i� S�Yal�I �70� (1MC I � o"`. �/� "/�L_LL� <br />� S yih <br />Paovoseo use oF euaort+e <br />LEGAL OESCPoPTION OF PPO% <br />LOT BLOCN <br />4/- /08 7 443 <br />CONSTRUCiION IOAN LENOER. ADDpE55. TEtEi'HIXdE NIIMBER <br />n�uMeiNo <br />OF <br />_ � BATHTUB <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. E7 <br />OR ITEM <br />SUB TOTAL S <br />PERMIT $ <br />FOR OFFICE USE ONLY: <br />FRONTFFTPRCK REAR SF.TPRCR <br />USE20NE IOT�PEA <br />HEIGNTLIMIT�TION NO.OFOWELLIN' <br />UNIT� <br />OCCUP�NCY NOOtSM1�RI[5 OCCUPANT�OAO <br />GROUP <br />FIREAURMREOf1 RFA50Y <br />FIRC.SPRINKIF.RPEO'O RE��ON <br />TYPE OF f,ON51 <br />UAiE <br />FEE <br />SIDE SEiBnCK <br />V�C�NI SITE <br />IlYES NO <br />I HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED THIS <br />APPI_iCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF lAWS AND ORDINANCES CaOVERNING THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOGAL LAW REGULATINO CONSTRUCTION OR THE <br />PERfORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />x�� ���� ��-a9-� � <br />SIGNANRE DATE <br />CITY BUSINESS UCENSE NO. <br />MECHANICAL <br />NO. TYPE OF EGUIPMENT FEE <br />rva. — rvnnvw um i a— n. <br />FORCED AIR SYSTEMS — B <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATIOt� FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD <br />FIREPLACE INSERT (WOOD <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />t'L�Nd1ECNNUMAGR I fEf I AECEIPTNO. <br />f � pl11LDMG <br />SIZE Of BLOGRI — <br />PWMOiNG <br />BRSEMENT MFCN�NICAI <br />f1YE5 I1 NO <br />ADD�IIONAL t'IAN C�1lCK <br />O1MER <br />S1�lE �UIIDING SURCHAqGE <br />GTY OF EVERETT runi�r,wonKs <br />LOCAL SALES <br />TAX CODE IS 3105 707AL <br />