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APPLICATIG.1 FOR CONSTRUCT�JN PERMIT/ <br />CITY OF EVERETT • BUILDING DIVISION {�C� <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 � <br />f7 DEMOUTION f 1 COMBINATION fl BUILDING I"1 MECHANICAL f 1 PLUMBING i l SIGN <br />PROJECr A D,AE; � UIC� ���� 4 �vC <br />D� d� <br />�S <br />nr ri�oNe <br />k� ve L�e,�e tl cU <br />ARCHITECTOFDESIGNER MaILADURE55 CIN ZIP PHONE <br />GENERALCONTRACTOR MAILPpORESS CIIY ZIP PIIONE SiATELICENSE� <br />MEC NICALCONTp�LTOR 61AIL�DDRE55 Cltt 21P PMONE STATELICENSEM <br />W ns-�L> <br />PLUMBIN�CONTHACTOR M41LA�DPE55 CIiV 21P PHONE STATELICENSE� <br />WNTRqCTPPICE OF WORH <br />��� HEATING SYSTEM: Cl GAS Cl ELECTRIC I-7 <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVLD CONTACT PERSON AHO PIIONE NO. <br />LEG�L oESCRIPTIIXJ OF PROPERtt (SHOWN BELOW OH <br />LOT OIOCN OF_ <br />PARCELTAXI.D.NUMBER <br />CONSiRUCTiON LORN L@NDER. AODRESS. TELEPMONE NUMBER <br />TYPE OF FlXTURE OR ITEM <br />WATER CLpSET (TOILET) <br />BATHTUB <br />LAVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 D�SP <br />UISNWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAF. ETC.1 <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE $ <br />FOR OFFICE USE JNLY: <br />FRONTSETBACN PEM SETB�CK <br />USF20NE LOT�R2R <br />IIEIGHTLIMITATION NOOFDw[LLWG <br />UNIiS <br />OCIXIPANCV NO Oi Si0RIE5 OCCUPFNT L04D <br />GPOUP <br />FIRE AURM RCO'D R[ASON <br />REO'O <br />f'UNS A <br />DATE <br />I HEFEBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION ANU KNOW THE SAtdE 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 Oq <br />N07. 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 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 1 COMPLY WITH THE STATE <br />C0�11'F±7fC�TORS LAVj�1B.27 f�CW AND 29v200 W/�C. <br />OATE <br />CI*V BUSME55 LICENSE NO. <br />MECHANICAL <br />FEE NO. TVpE OF FIXTURE OR ITEM <br />' A/C—AMNDLGUNITS—H.P. <br />; FORCED AIR SYSTEMS — B.T.U. M E.A. <br />� HEAT PUMP <br />' UNIT HEATERS — B.T.U. M <br />� CLOTHES DRYERS <br />� VENTILATION FAN <br />; RANGEHOOD <br />� WATER HEATER <br />' WOODSTOVE <br />i METAL FIREPLACE (INOOD BURNIN�i) <br />� FIREPLACE INSERT WOOD BURNING) <br />i GAS FIREPLACE � <br />! GAS RANGE , <br />SIOE SEiBACK <br />��C�NT SIiE <br />r1YES �i NO <br />FEE <br />� <br />E%HAUSTFAN � <br />—�_ <br />i <br />SUB TOTAL $ ��J � — <br />PERMIT $ �S , — <br />TOT�L FEE $ � � <br />PIANGN@CHNU1.1f�@� FE@ PECEIPTNO. <br />�fii� 9 ci:/' <br />DUILOING <br />SIZF OF OIDGRI. <br />PLIIMpMG <br />BASENENT MECHr1NIC�L <br />flYES •^ - <br />AD�I1109A� PI AN CMECK <br />OTHFR <br />STqT[ pWL�INC SURCMAq�[ <br />CITY OF EVERETT vunuc wonKs <br />LOCAL SALES <br />TAX CODE !S 3105 To7AL <br />