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APPLICATIO�� FOR CONSTRUCTIVN PERMIT� <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION O BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br />IEN�NT �All�0ORC55 CIIY ZIP vnOrve <br />�RCNIiCGT OB DESIGNER M�II ADUnE55 Cltt 7�� �HpNE <br />GFNFOAICONiR1f.iIX1 MM�AOORE55 GIIY , lIP PIIONE $IAIEUCENSE� <br />PLV�+BING LONiR�CTOA <br />GONTMCT VRiCE OF WORK <br />DE$ RIBEY/ORKAND �� �RlE, <br />LL <br />LEWl0E5GPIPT10N OF PROPERiY <br />LOT BLOCK _ <br />PARCELTA%ID.NUMBER <br />CONSTRULTIOH IONr LENDER, ADDRFSS, TELEPNONE NOMBER <br />TYPE OF flXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />OISHWASHER <br />LAUNDRYTRAY <br />CIOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TO' <br />PERMIT <br />FOR OFFI�E USE ONLY: <br />iRONi SETB�G PE�R SETB�GK <br />USEZONE IOi�REA <br />NEIGNT LIMI7�TION NO OF DWELIING <br />UNIfS <br />OCCUPANCY NO 0� SI�aiFS OLCUPANT LOAO <br />GRWP <br />FlRESPRINKIERREO'D nE�50N <br />ov <br />u�r. <br />C17V <br />Gtt <br />� <br />rno cories� <br />FEE <br />S <br />E <br />S <br />SIDE SETB�CN <br />VACANi SIiE <br />❑YC^ ❑ NO <br />liP PNONE SifiTE L�CENSE � <br />ZiP PHONE STATEIICENSE� <br />HEATING SYSTEM: J� GAS ❑ ELECTRIC ❑_ <br />CONTACTPC�SOM�NDPHONENO <br />I I1ERE�Y CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATIt)N AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS Of lAWS AND OR�INANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WH'cTHER SPECIFiED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO G�VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL Lf.'N REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNF.R OF THIS PHOPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 VlAC. <br />x�.i'l.�,cm�a-�,-+�..+..f�� o ja/.S'/97 <br />SIG �fURN E �r-�— DA7E ��— <br />�/��[� <br />CITY Bl15iNE55 UCENSG NO. <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />"—NFINDLG UNRS ' <br />F. .aCED AIR SYSTEMS � <br />HEAT PUMP � <br />UNIT HEATERS ' <br />CIOTHES DRYERS � <br />RANGEHOOD ' <br />WATER HEATER � <br />WOOD STOVE <br />MEfAL FIREPLACE (WOOD BUFNING) ' <br />FIREPLACE INSERT (WOOD BURNING) i <br />GAS FIREPLACE ' <br />GASRANGE � <br />SUB TOTAL S <br />PERMIT S � / <br />TOTALFEE E o : � <br />rinr+c�mcK r+uunrn � � reF � n[r.eirr r+o <br />nunnn+r, <br />SiIE OF OLDGrtI <br />PIUMpING <br />AASEMENi MEf,11nNICnI <br />❑YE$ ❑ NO <br />RD�IIION�L PIAN Cnf.GN <br />O111E0 <br />$l�lE Olnl0�N6 S�IOC1URf,E <br />CITY OF EVERETT rumir,wonKs <br />LOCAL SALES <br />TAX CODE IS J105 TOTAL <br />