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APPLICATItiA FOR CONSTRUCTrON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />fl DEMOLITION fl COMBINATION fl BUILDING f-1 MECHANICAL t� PLUMBING fl SIGN <br />PROJECT ADDRESS �`' _n /� <br />/'/ ir ronrvC� ,y�l-� <br />JasEP�-� �,Ur14ERM^2.�1�SSManikl��(AVI:. �VE�F1� `�Z8�y sJ3-Zz3y <br />iEN�NT MRILADDRESS QTV 21P PMONE <br />�RGHITEGTORDESIGNER M�ILADORE55 CITY IIP PNONE <br />GENEf1ALCONTPnCTOR MAILADDRE55 <br />MECH?�ICALCONTRRCTOR MRIUDDRE55 <br />�Ja%II�iJ <br />PLUMBINGCONTRRCTOR MAILADDRESS <br />CONTRACT PRICE OF WORN <br />DESCRIBE WORK AND SOUAqE FOOT�GE INVOLVEO <br />LEGA� DESCRIpT10N OF PROPERTY <br />LOT BLOCK _ <br />P�RCEI TiVf I.D. NUMBER <br />CONSTRUCTION LOAN LENUER, ADDRE55. TELEPHIXJE NIIMBER <br />PLUMBIN6 <br />NO. TVPE OF FlXTURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORYIWASH BASIN) <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />CLOTHES <br />URINAL <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK fSFFVICF _ RAR F1 <br />FOR OFFICE USE ONLY: <br />FRONT SETPRCN REM SFTBALK <br />USE ZONE <br />NEIGNT LIMIIATION <br />REOD <br />SUB TOTAL <br />PERMIT <br />S <br />$ <br />SIDE SETBRCN <br />cnv zm <br />cirv <br />PHONE $TATE LICENSE • <br />HEATING SYSTEM: (l GAS fl ELECTRIC fl <br />CONTACT PERSON AND PIIONE NO. <br />1 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 WILL BE COMPLIED 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 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 I COMPIY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />X ��— l.b <br />SIGNRTURE �ATE <br />CITY BUSINESS LICENSE N0. <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />rv�.—rvn���w v�a�a—n.r. <br />FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />VENTILATION FAN <br />RANGE HOOD <br />INSERT <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />rinNci�ECKr+uM�en , � reE � nEc�mrNo. <br />IOTARFA VPCANi51TE rcw <br />f1VES f1N0 p111LDING <br />NOOFDWELIING SIZEOFBIOGrti <br />UNITS p�UMOING <br />OGCUPANTLOAO BASEMENT M[f,11ANICAI <br />IlYES il NO <br />RFASON PUUIil04�L PL�N G�ICCK <br />on�en <br />nrncov <br />sTnie euaoiuc sunc�mnce <br />ainNsnrrnovener CITYOFEVERETT runur,wonns <br />IOCAL SALES <br />�q�E TAX CODE IS 3105 707AL <br />