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APPLICATI�.N FOR CONSTRUCI �ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 :EDAR STREET • EVERETT, WA 9fi201 • 259•8810 <br />�1 DEMOLITION f 1 COMBINATIUN �I BUILDING �MECHANICAL I 1 PLUMBING fl SIGN <br />PROJECT ADDRESS 1 <br />, MFILADDRE55 <br />r.� <br />an zir <br />�',y�3 : tiz- E 3'n � <br />����oNE <br />ARCHRECTOfi0E51GNER MAILADOfiE55 CIIV ZIP PHONE <br />GENER�LCONiPnCTOR MAILR��R[55 CIIY ZIP PIIONE STATELICENSE� <br />MECH�NICAL <br />SOUARE FOOTRGE <br />IEGRL OESCRIPTION OF PFOPERTY (SHOWN BELOW OR ATTACH TWp COPIES) <br />�or — . e�ocK or <br />CONSTilUCT10N LOnN LENDER, A�DRESS. TfLEPMONE NUMBER <br />PLUMBIN6 <br />NO. TYPE OF FlICTURE OR ITEM <br />BATHTUB <br />LAVATORY <br />SHOWER <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />DRINKING FOUNTAIN <br />FLOOR DRA�N <br />BACKFLOW PREVENTERS <br />arv <br />FEE <br />SUB TOTAL 3 <br />PER?AIT 5 <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETOACK RE�R SETOACN SIDESET�nLK <br />USE ZONE LO7 PREA VACANT SITE <br />flYES fl NO <br />HEIGIITLIMITqT10N NO.OFOW[ILING SIZEOFBLDGrtI. <br />UNIiS <br />TYPE OF CONST <br />pATE <br />9ASEMENT <br />tlYES Il NO <br />STATE LICENSE � <br />ZIP PHONE STATE LICENSE � <br />HEATING SYSTEM: VI GAS f 1 ELECTRIC ❑ <br />f.ONTaCT PERSON PND PIIONE N0. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUMF 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 BY THE <br />OWNER Or THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />,!`_�fr.�u�-2�.r1 s/r�9� <br />SI A y���Z� /� DA <br />Y' � <br />CIN BUSINES$ UCENSE NO. <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />A/C — AhiNDLG UNITS — H.P. �—� <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METALFIREPLACE(WOOD <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAVST FAN <br />SUB TOTAL 5 <br />PERMIT $ <br />PLAN CIIECN NUM13[R I FEE � RECEIPT N0. <br />PUILDING <br />PLUMOING <br />MECIIANICAL <br />ApD1110NA� PLAN CN[CH <br />O1HER <br />StATE OUIIOMG SURCHnRGE <br />CITY OF EVERETT ruoi.ic wonKs <br />LOCAL SALES <br />TAX CODE IS 3105 707AL <br />