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APPLICATI�..�1 FOR CONSTRUC7.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />f l DE�AOLITION ( 1 COMBINATION �� BUILDING I-1 MECHANICAL f� PLUMBING fl SIGN <br />PROJJ�ECo'ADD�$CkoLT f Iwc.� <br />'�! S�3 <br />OK' MAILApDRESS Cltt IIP PMONE <br />A'�✓l�C. S✓-nG%lB�_ -�� <br />21P <br />w� <br />GENERALCONiRACTOR MAILqO�(lESS CIIY ZIP PIIONE STATELICENSE� <br />OESCRIBE WORK AND SOl1ARE FOOTAGE INVOLVED <br />PPOPOSEDUSE <br />LEGA�_ OESCRIPTION OF PPOPERtt <br />�ot o�ocrc <br />CONSTRUCTION LOAN LENDER, AD�RESS. iELEP110NE NUMBER <br />PLUMBING <br />NO. TVPE OF FIXTURE OR ITEM <br />WATER CLOSET � fOILETI <br />LAVATORY(WASH BA', <br />SHUWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. Ei <br />FOR OFFICE USE ONLY: <br />',70NTSETDACK RE4R SET��CN <br />USE 20NE <br />IIEIGHT UMITATION <br />OCCJPANCY NOO�Si0RIE5 <br />GROUP <br />PIRE ALARM REO'D <br />FIRE SPRINKLEN REOD <br />SUB TOTAL 3 <br />PERMIT $ <br />TOTAL FEE 5 <br />HEATING SYSTEM: yC�GAS ❑ ELECTRIC ❑ <br />su <br />i <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 WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES VOT PRESUME TO G�VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGU_FTING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFURM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />x L�v1n^"� /�� 3- Z L- 9 <br />SIGNATURE DATE <br />CITv OUSMESS LICENSE NO. <br />NO. TYPE OF ftlCTURE OR ITEM FEE <br />A/C — AMNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />WATER HEATER <br />WOOD STOVE <br />FIREPLACE INSE <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL 5 <br />PERMIT S <br />TOTAL FEE S <br />SIDESET04CK � PLANCHECNNUM�GR I r�e I RECEIPTNO. <br />LOTAREA V�CANTSIiE FEES <br />f1YES fl NO OUILOING <br />NO.OFOWELLING SIZEOF�LUGRI. — <br />UNITS <br />PWMpING <br />OCCUPANTLOAO BASEMENi MECHANICAL <br />fl YGS �l NO — <br />REASO4 ADOI710NA1 PLAN CH[CK <br />OTHER <br />REASON <br />SIATE OWLDING SURG114RGE <br />PLANSAPPPOVEDOY CITY OF EVERETT ruoucwonKs <br />LOCALSALES <br />osrr. TAX CODE IS 31U5 TOTAL <br />