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_ ^ <br />APPLICATI�..� FOR CONSTRUC7.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />�l DEMOlIT10N fl COMBINATION �� BUILDING rl MECHANICAL Il PLUMBING fl SIGN <br />�/`% 0 .� �if /�/'� /' � <br />o n MRIL RD�RESS L y/c /�! p i[ /� iCl; zir PH'JNE <br />Dfj/1ROL i� s%���Qni✓ M/1 �%rcrr�r4� 9'820� a�<� �s-s-9�'/� <br />TENRNT MPILADDRE55 CIIY IIP PIIONE <br />D�/C/l e t � S!'7/J� l2 a r✓ /�' £.�l i s S�%- /�l �• <br />ARGHITECT OR DESIGNEfi MFIL Al1�RE55 CITY ZIP PHONE <br />�� <br />GENERALCONTPAC7n0R MAIIA�URE55 CITV ZIP PNONE STF7ELICENSE� <br />��/r i <br />MECIMNICAL CONTRACTOR MAIL ��DfiFSS QTV Z�P �'��ONE STATE UCENSE � <br />PLUMBINGCO�NT"R,^ACTOR MAILAU�FE55 <br />% / / <br />CONTPACT PRICE OF WORK <br /><3 � <br />DESCRIBE N/ORK AND SOUARE FOOTACaE INVOIVED <br />(SHOWN <br />LOT BLOCN <br />CONSTRVCTIONIO�NLENDER,�DDRESS.TELEPHONENUMBER <br />� <br />Fll(TURE OR <br />WATER CLOSET <br />LAVATORY(WASH 8A: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRV TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />BACKFLOW PREVENTE <br />SINK (SERVICE — BAR. <br />FOR OFFICE USE ONLY: <br />FRONTS[TBRCK RERRSETBACK <br />USE 20NE <br />HEIGlI7 LIMITATION <br />OCCUPANCV NO( <br />GROUP <br />FIRE AURM RE00 <br />FIPE SPRINKLER RI <br />TVPE OF CONST. <br />LOTARER <br />COPIE51 <br />FEE <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />SIOE SETBALN <br />NO.OFDWELUNG <br />UNI7S <br />VRCANT SIiE <br />flVES fl NO <br />SIZE OF BLDG�TI. <br />LIY <br />HEATING SYSTEM: 1=] GAS 17 ELECTRIC ❑ <br />GONiACT PERSON RND FHONE NO. <br />• <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPIICATION 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 V�OLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINO 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 COMPLY WITH THE STATE <br />CONTR TORS LAW 7827 RCW AND 296200 WAC. <br />X P' �'�l `" �L i ���'`� !� � ��� <br />SIGNPiURE DRE � <br />GiV BUSINESS UCENSE NO. <br />NO. TYPE OF FUfTURE OR ITEM <br />AIC — A/HNDLG UNITS — H.P. <br />� FORCED AIR SYSTEMS — B.T.U. M <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />METAL <br />INSERT <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />PUN CHECK <br />C <br />O111L01NG <br />P W MOING <br />OCCUPANTIOAD BASEMENT MECHANIGAL <br />❑YES C7 NO <br />_ _ . _ _ _ . ADDIiIONRL PLAN CHECK <br />OTHER <br />STAIE DUILDING SURCII0.RGE <br />CRY OF EVERETT �ueuc wonns <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL S <br />PERM�T 5 <br />TOTAL FEE S <br />FEE RECEIPi NO. <br />FEE <br />• <br />