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APPLICATIQ� FOR CONSTRUCT'iN PERMIT �,�}� <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 �'���"�' <br />j ��--- <br />I-1 DEMOUTION fl COMBINATION ❑ BUILDING ❑ MECHANICAL Ci� PLUMBING ❑ SIGN <br />1FNANT 4�Il�Od�E55 CIfY 71P �nOrvt <br />ARCIIITEGTdiDE51GNER MIUlA00�E55 GITY 711� PHONE <br />PIIONE cGTEt10EN5E• <br />l��' �-�i-U'oG7_ �ep?6BZo <br />YECNNiICAI ONTR�Ciq1 M�ILAD011E55 Cltt � ZiP PIIONE ST�TEUCENSE� <br />PlU4lNGCONTP�CTOR MMI�DORE55 CIfY IIP PNONE STATEIICENSE� <br />viarosEo use oc e�ntdra <br />�aw oescamna� a rnorEan �s�awn uEiow on �rt�cN nw coaies� <br />lOT MOCK OF <br />PMCELTI�)t I.D. M/A�lER <br />CONSTRULTd/ LOM! LENOER. �DDRE55. TELEP110NE M1MlER <br />�V��� <br />NO. TYPE OF FlXTURE OH ITEM FEE <br />WATER CLOSET (TOILEn ' <br />BATHTUB � <br />UVATORV (WASH BASIN) � <br />SHOWER ' <br />KITCHEN SINK 8 DISP i <br />DISHWASHER ' <br />LAUNDHVTRAY � <br />CIOTHES WASHER � <br />URINAL ' <br />DRINKINf9 FOUNTAIN � <br />FLOOR DRAIN ' <br />BACKFLOW PREVENTERS � <br />SINK (SERVICE — BAR, ETC.) <br />� <br />i <br />i <br />� <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE f I <br />FOR OFFICE USE ONLY: <br />Fqd1T5ETBACN pE�R! <br />USE ZONE <br />NEICNT UMIT�TION <br />OCCUP�NLY MO M SIOIYFS <br />GfqUP <br />FIRE SPHINKIEq pE0'D <br />FlRE MM d PEO'D <br />�� <br />HEATING SYSTEM: O GAS ❑ ELECTRIC O <br />�����Mp5�,2X�°,°'�;�� / 7'67 �o� � <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 OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILI BE COMPLIED WITH NMETHEH SPECIFIED HEREIN OR <br />NOT. THE 6RANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REIiUUTINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTfiUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPIY WITH THE STATE <br />CA RACTORS LAW 1827 RCW AND 296.200 WAC. <br />���%�'� 1oq`'4�v <br />x <br />SpN� DI1TE <br />GTY BUSINESS IICENSE NO <br />TYPE OF EOUIPMENT I FEE <br />FORCED AIR SY <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRVE <br />RANGEHOOD <br />WATER HFATER <br />WOOD STOVE <br />METAL FIREPLA( <br />FIREPLACE INSf- <br />GAS FlREPUICE <br />GASRANGE <br />GAS PIPING <br />TOTAL <br />f <br />S <br />PI�NCOECNNOMBEO IfEP IRECFIPiNO <br />LOTApEA V�C�NT9TE rcw <br />O�ES ❑ � BUIl01NC <br />IqOFUWELLIN6 512EOFBLOG/il <br />UN115 PlU�A01NG <br />OCCUPANTIO�D BA$EMENT MFCIInNIC�I <br />❑YES ❑ NO <br />�DD�110N�1. M AN CNF.CN <br />RE�SON <br />on�En <br />RE�[pN <br />STAIE DU�lO�NG SIIRC1URf.E <br />PI�NSMPPOVEDBY CITY OF EVERETT �IIBIIf. WOBNS <br />LOCALSALES <br />.,... TAX CODE IS 3105 TOTAL <br />