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APPLICATION FOR CONSTRUCTION PERrV11T <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREEi • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOUTION fl COMBINATION fl BUILDING �ECHANICAL �l PLUMBING �l SIGN <br />PROJECT ADDFESS . � �a/ / /, � �I � G%/���� j ���� j <br />_7/'� / � n/ U <br />��n. qp PNONE <br />ziv <br />�ooaess ��TM <br />CENEYlR NIRnCTO{i ��� MU�}_�'Y� 'y/� ��n' 21P PIIONE � �S7AiELICENSE� <br />T?M1E"'` ' Hu► , a�. 2�'�- - `� �o /YD i/iidi�/��3 �� <br />^ PIIONE STATE L�CFNSE � <br />MECH�¢�I�C�j��IK f.ITY ZIP <br />�R�J 1 � �v.. <br />p�p , MAILADDRE55 CIfY ZIP fHONE STAiEUCENSE• <br />CONTR�CT CRICE OF WORK�� SG� <br />pE$CqIBE WORN �ND SOUARE FOOTAGE INVOLVED <br />�/fS%/aGL /'(��'�i� CC <br />PRO{'OSED USE OF BUILDING <br />LEG�L DESCN�PT�ON OF 7�OPERTV ISHOWN BELOW OR ARACH TWO COPIES) <br />LOT BIOCK OF <br />PARCEL T/JI LD. N�MBER [�� [/ C n /t <br />7�� l l��(�� ���V f <br />CONSTRUC710N lOM! LENDER. �DDiiE55. TELEP ONE NUMBER <br />NO. TYPE OF FlXTI�RE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK d DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />U�INAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />cwK isERVICE — BAF. ETC.) <br />SUB TOTAL $ <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />IROHTSF.TP�CK RE��SFTBRCN <br />USEZONE LOTRREA <br />HEIGHTLIMIiAT10N NNIOFDW[LUNG <br />onTE <br />FEE <br />$IUE SETP�CN <br />VRCANI $IiE <br />HEATING SYSTEM: JXGA <br />COYTACT PERSON ANO PNONE NO � � <br />rl ELECTRIC f� <br />��,� 'ir�> > > 4�7 � � <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS pF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIEO WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCiION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PRO T ERFORM THE WORK FOR WHIGH <br />APPLICATION I ADE I COM LY WITH THE STATE <br />CONTRACT L . R/CiN AND 298. WAC. <br />� � r-- r <br />i� <br />x�.� .��ec D�TE <br />CITY BUSINE55 UCENS[ NO. <br />NO. TYPE OF EOUIPMENT FEE <br />rv� — wnn�w urvn a —.,.� <br />FORCED AIR SYSTEMS — B: <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD E <br />FIREPLACE INSERT (WOOD <br />GAS FIREPLACE <br />GAS RANGE _ <br />GAS PIPING _ <br />E%HAUSTFAN <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE S <br />PUN CIIECK NUMAER FEF I PECEIPT NO. <br />i 1 YES f i NO O111L�MG <br />SIZE OF 01.DGR1 <br />PLVMPING <br />B�SEMENi MEC114NICAL <br />IlYES It NO <br />FODI710NA1. PIAY GH[CN <br />0711ER <br />STATE AIIiIDINC SUfiC11nf16E <br />CITY OF EVERETT runucwonKs <br />LOCALSALES — <br />TAX CODE IS 3105 70TAL <br />