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� <br /> APPLICATItir�l FC/R CONSTRUC7 �ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> fl DEMOLITION fl COMBINATION I-1 BUILDING fl MECHANICAL �l pLUMBING fl SIGN <br /> PROJECT AODRESS <br /> / os � � S �" <br /> OWNER M�ILADDRESS Cltt IIP PIIONE <br /> (-�a� Z,=�N i l`iD 5 1�1 N e Lvt;�-r <<`s�� 1 3S�- ��1 u_� - <br /> IEN�NT MAILA�DRE55 CITY ZIP PIIONE <br /> �RCHITFCTORDESIGNER MFIIA�ORE55 Cltt ZIP PHONE ' <br /> GENEOpLCONTMCTOR MAIL�DDRE55 CIiV 21P P110NF STATELICGNSE� <br /> MECN C�W O-NT^R4C^TOR - MAI�AOORE55 Citt ZIP PIIONE STATE UCF.NSE� <br /> � `--� <br /> PLUMBINC�CONTRACTOR M>ILADDRE55 CILY 21P PNONE STATEUCENSE� <br /> CONTN�CT PRICE OF WORK <br /> HEATING SYSTEM: GAS �l ELECTRIC �l <br /> OESCRIBE WORK ANO SOUARE F00TJ1GE INVOLV D CONTACi PFR50N AND P110NE N0 <br /> � P N J e !aJ <br /> I FIEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDIN4 APPLICAT�ON AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF , <br /> WORK W�LL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGIILDESCRIPTIONOFPROPERTY�SHOWNBELOWOi1A7T�CNTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE <br /> �oi e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW qEGULATING 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 /> PMCEL TNt ID.MIMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONS1i7lICTION LOAN LENDER.�DDRE55,7ELEPNONE NUMBER x / I I 3 1� <br /> SIGN�TURE DRTE <br /> CITY 6USINE55 LICENSE NO <br /> PLUMBIN6 MECHANICAL <br /> NO. TWE OF FlXTURE OR ITEM FEE NO. TYPE OF EpUIPMENT FEE <br /> • WATERCLOSET(TOILEn � A/C—AIHNDLGUNRS—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 6 DISP i CIOTHES DRVERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRYTRAY ; RANGEHOOD � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BUiiNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURN�NG) � <br /> BACKFLOW PREVENTERS i GASFIREPLACE <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE <br /> � GAS PIPING ' <br /> ; EXHAUSTFAN � <br /> � ' <br /> SUBTOTAL S ; SUBTOTAL S ; ^ <br /> PcRMIT S � PERMIT 5 i � <br /> TOTAL FEE S ' TOTAL FEE S ' l <br /> FOR OFFICE USE ONLY: <br /> FPONT SE7PALN RERR SFTBRCN SIOE SETB�CR �UN CIIECK NUMOF:R FEF PEf.EIPT NO <br /> �� <br /> uSezoNe LOTRREA V�CRNi51TF. FEE VALUATION FEE <br /> � <br /> i�res �� No owiowc ; <br /> IIEICNT UMIUTION NO OF DWELL�NG SIZE OP BIOGRI ' <br /> UNII$ PLIIAIpING i <br /> OCCUPANCY ND O�SIM1l[S OCCUP�NTl0�0 PASEMENT MECIIaNICAL � <br /> GnWP ' _ <br /> f1YE5 II NO � <br /> FIRE�URM FEO�D �FASON <br /> ADD�110NOL PUN GIFCK i <br /> on�en ' <br /> � <br /> Fiae SrnwKi En neon nensor� � <br /> smi[nwiou+c suncr�nnce I <br /> irreorr.or+sr rtnNsnrrnovenor CITYOFEVERETT rumir.wonKs <br /> LOCALSALES — — --- <br /> DAIE TAX CODE IS 3105 70TAL <br />