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APPLICATIL.+1 FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION fl COMBINATION f-I BUILDING �l MECHANICAL (� PLUMBING fl SIGN <br />PROJECT ADDRESS <br />��'i�3 ,ae. S�� <br />ONMER � . � MAILADDRE55 CITY _ ,ZIP rn�nuv <br />.. / L��' V //L!� C_L'� �"J'dGti� �-.:d ." G � <br />TENANT nLA�URESS qTY ZIP PHONE <br />ARCHITECTOROESIGNER MAI�A��RESS GITV ZIP PHONE <br />MAILADDf1E55 � CIiY ZIP PHONE STATE <br />.•.-•.•••••....��....�.�.. ��v.. m�i�nwrmaa CITV 21P PHONE <br />STATE UCENSE � <br />PLUMBING CONTRACTOR MAIL ADDRE55 CI7Y ZIP PHONE STATE LICENSE • <br />WORN <br />DESCRIBE WORK ANO SOURRE FOOtAGE INVOLVED <br />�EG�L O�EjS�CR�IP�TION OP PROPERTY (SHOYM BELOW OJR —pTTR/CN T <br />LOT �[[_ BLOCK � OF C✓Ti <br />ir�_ J- �' �' Z• ' _ _ .' i <br />PLUMBINO <br />NO. TYPE OF FlXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />d- BATHTUB / <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />_L DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL S <br />PERMIT S <br />__. TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBALN REARSET9�CN SIDESETBA� <br />�_ � -, _ � .— <br />USEZONE <br />� Z <br />NEIGHTUMIT�TION _ I <br />NO OL SiGA:ES <br />LOT <br />HEATING SYSTEM: Cl GAS ❑ ELECTRIC fl <br />CONTACi PERSON RNO PMONE NO. <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEfiNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER S!'ECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DCES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW qEGULATING CONSTRUCTION OR THE <br />PEFFORMANCE 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 COMPLV WITH THE STATE <br />CONTRACTOFS LAW 1827 RCW AND 296.200 WAC. <br />x �//'�'S <br />SIGN�TUPE D�TE <br />CITY BUSINE55lICENSE NO. <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />A/C —A/HNDLG UNITS — H.P. � <br />FORCEDAIRSVSTEMS—B.T.U. M E.A. � <br />HEAT PUMP � <br />UNiT HEATEPS — B.T.U. M � <br />1 CLOTHES DRYERS . <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />A7ETAL PIREPLACE <br />FIREPLACE INSERI <br />GAS FIREPLACE <br />GAS PIPING <br />EXHAUSTFAN <br />� SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE S <br />3�%�%, L�_. <br />PUNCHE NIIVOF FEE PECEIPTN <br /></ _3i � 35/.,�,Z �/_3 <br />FEES vswennw <br />�YES fl NO BWl�wO <br />NOO:DWELUNG S12EOFBLOGRI <br />uNirs �536 SF Liv„�w <br />S, �G` PWMBING <br />OCCUPRNTLOR� B�SEMENT MECIUMCAL <br />N A nves � <br />pEp50N �DDITIONA� P�AN CIIECN <br />OTIIER <br />REASON <br />STATE OUIt01NG SURGIIARGE <br />�LANSN'PROYEDBY CITYOFEVERETT vuoucvronKs <br />�J# LOCAL SALES <br />�nTe 5/23/9S TAX CODE IS 3105 TO7AL <br />