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APPLICATIO. . FOR CONSTRUCT� �N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />❑ DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: <br />•qGMTECTORDESIGNER MFII�WRE55 �iry ��p <br />CENEPILLCONiR�GiO{1 M1uL/�WRE55 UTY 76• PIIONE SI�TEIICFNSE� <br />MECHANICALCONTR��Tqi MAI�ADDRE55 417V ZIP P11pNE S1aEUCENSE� <br />RW �L�n,fR N�J s�ia iwo*N D� ,uE �t�1ilr�Cu��� wf�- �i8a�� �� 3•/4/r RuPc.J�roP�/�'�— <br />PIUMBINGCONIR�CIOR M�IL�DDRE55 CI 21P P1qNE STREl10EN5E� <br />CONTMCT PqICE OF YN1iK <br />HEATING SYSTEM• ❑ GAS ❑ ELECTRIC ❑ <br />DESGAISE WdiK �NO SpV11qE FppTAGE INVOIVED CON1�Ci PEPSONANO P1pNE Np <br />iEau oescr�vnar� a rnori <br />ioT e�ocK <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 WILL BF COMPLIED WIiH WHETHER SPECIFIED HEREIN OR <br />aeiowaa�n�cMrwocovies� NOT. THE ORANTIN(i OF A PERMIT DOES NOT PRESUME Tl� GIVE <br />_ ov AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOCAL LAW REGULATIN(i CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OW1� R OF THIS PROP�t TY TO PERFORM THE WORK FOR WHICH <br />APPQICATION J$^ M/CbE AND I COMPLV WITH THE STATE <br />CON'�RACTOqb �Inw�Se,�7 RCW AND 29f 200 WAC. <br />CONSTRUCTIp/ LO/JI IENDER, AppQE55. TELEP1qNE MMEER <br />��Q <br />NO. TYPE (?F FlXiURE OR ITEM <br />WATEH CIOSET (TOILEn <br />BATHTUB <br />LAVATORV(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHEH <br />LAUNDRYTRAY <br />CIOTHES WASHER <br />URINA� <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.1 <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />CRONTSETB�CK PE�RSF.TBACK <br />uSE ZONE <br />HEIGNT LIMITATION <br />OC�C1V�ANCY Iq c1 <br />FINE SPRINKLER REC <br />FIRE AUNM REO'D <br />IOT�REA <br />NO OF OWEILING <br />llNlit <br />SIOE SFTBACN <br />/T � 7 <br />I <br />CITY BUSINE55 LICENS[ Np <br />MECNANICAL <br />FEE NO. TYPE OF f� �UIPMENT <br />' NC—NHNDLOUNfTS <br />; FORCED AIR SYSTEMS <br />� HEAT PUMP <br />� UNIT HEATEPS <br />� CLOTHES DRVERS <br />' RANGEHOOD <br />; WATER HEATER <br />� WOOD STOVE <br />' MEfAL FIREPLACE (WOOD BUHNING) <br />� FIREPLACE INSERT (WOOD BURNING) <br />' GAS FIREPLACE <br />; GAS RANGE <br />� GAS PIPING L UhK'n�0 r�w l iT <br />V�C�Nt SItE <br />❑Y[5 ❑ NO <br />S12E OF BIOCrt I <br />❑YES O NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PI�N CIIECN MIMBFR <br />OUItDINf. <br />PLIIMBING <br />MfCH11NICM <br />�ODI IION�L �UN Cnf.Ck <br />O7NER <br />ST�IE BIIIIDINC SUPp111�GE <br />runnr. wonKx <br />TOTAL <br />SUB TOiAL f <br />PERMIT f <br />TOTALFEE S <br />fEF �NECEIPTNO <br />� <br />