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�� r <br />APPLICATIV�1 FOR CaNSTRUCi .ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />O DEMOLI'nON fl COMBINATION fl BUILDING fl MECHANICAL PLUMBING f� SION <br />PROJECT ADDRESS <br />-►� a o �+Ae.os�N Q� �,t�e�.�c- <br />om+en ce����� MaIL�UDRESS cm nr 1'NONE <br />4'�f -Bo90 <br />mrvnrv� MAILApDRE55 CITY 21P PeONE <br />TOW� 1- Coua�.e�1 <br />ARCNITECTOROESIGNER MRILA�URE55 GITY ZIP PNONE <br />C�ENERALCONTR�CTOR M�ILAUDRESS CIIY ZIP PIIONE STRELICENSEII <br />F��<<-� As�. Q�.�x 3,�� �3E:u.avva wA. R80o9 I'�b���e-« <br />MECMANICRLCONTR�CTOR MMLAODRESS CITY ZIP � PH04E STATELICENSE• <br />PWMBIN�3CONTRACTIXi MAILADDRE55 CIiY 21P PHONE STATELICENSE� <br />DESCRIBE WORN �ND SOUARE FOOUGE INVOLVED <br />PROPOSED USE <br />BELOW OR RTfAGH TWO <br />l0T BLOCK <br />PARCELiA%I.D.NUMBER <br />CONSiRUCTON LOAN LENDER, ADDRE55, TELEPNONE NUMBER <br />PLUM8INU <br />NO. TYPE OF FlXTURE OR ITEM <br />a WATER C1.OSET (TOILET) <br />BATHTUB <br />IAVATORY(WASH BASIN) <br />SHOWER � <br />KITCHEN SINK 8 DISP <br />DISNWASHER <br />LAUNDRYTRAY <br />CIOTHES WASHER <br />URINAL <br />DRINKINO FOUNTAIN <br />FLOOR DRAIN <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK RE�p SF.TBACK <br />USEZONE <br />HEIGNT IIMITATION <br />OCCUPANCV NO ( <br />GROUP <br />FIPE AURM (tE0'D <br />LOTAREA <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACT PERSON AN� PNONE N0. <br />I HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAM.E 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 QIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOGAL LAW RE6ULATINO 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 S7ATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />x�.�.�-u.N� 'J4.�N"' 8-\�-9�1 <br />SIGNATURE DATE <br />QTV BIl51NE55 LICENSE NO. <br />MECMANICAL <br />FEE NO. TYPE OF FlXTURE OR ITEM <br />�A/C — AMNDIG UNITS — H.P. <br />' FOHCEO AIR SYSTEMS — B.T.U. M E.A. <br />L�NITHEATERS—B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />HEATER <br />STOVE <br />/ i GAS FIREPLACE <br />�.) � � GAS RANGE <br />� ' GAS PIP!NG <br />���' � EXHAUSTFAN <br />� <br />SUB TOTAL S ' <br />PERMIT S i � ) <br />TOTALFEE $ � � <br />SIDE SETBACN PIAN CIIECN NIIMBER � FEE <br />NO OFUWELLING <br />UNITS <br />REASOY <br />oRrE <br />VACPNT SITE <br />IIYES ❑ NO <br />SIZE OF BLDGRI. <br />flYES Il NO <br />BUILDING <br />PLUMO�NG <br />MECHANICRI <br />AU01➢ONAI PLAN CHGCK <br />OiHER <br />STATE BWLDING SUACHARGE <br />CITY Uf EVERETT �UBIIC WOPKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL S <br />PERMIT $ <br />RECEIPT NO. <br />FEE <br />