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� <br />APPLICATIO.J FOR CONSTRUCT�JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ S,IC�•N <br />PROJECTADDRESS:�� ��-(�(�"jL�(.� t`1J�lC C-l� `t(�ZvI ri <br />�qGNI�EGT OR DESIGNER • MAII AOD�E55 Cltt 71P PHONF. <br />zBZ-��Ov <br />r.cucwuenutn�fTM M�IL�UDPE55 G1Y �P � _ PHONE _ � $IATEUCENSE� <br />MECNAN�CAL <br />GOMIWI4TPN1{;lU�WUqry.i ���_ <br />4R V <br />DCSCRIBE MIORI( �NU SOU�AE FOOT�GE INVOIVEU <br />LEGAL OESLRIPTION OF PROPF <br />LOT BIOCK <br />CONSTRUCT1qN lON1 lENOEN. ADORESS. <br />PLUMBINO <br />NO. TYPE OF Fl%TU <br />WATER CLOSET (TOILE <br />LAVATORY (WASH BASII <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />LAUNDqY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTE <br />SINK (SERVICE — BAR, <br />BEIOw OR ATT�GH <br />OR ITEM <br />SUB TO' <br />PERMIT <br />lr <br />` <br />S <br />5 <br />CIfY <br />FEE <br />FOR OFFICE USE ONLY: <br />FRONiSETB�CK RE�R SETBACN 9DE SETBACH <br />USE20NE <br />HEICNT IIMIT�TION <br />OCdUPANCY <br />GAOUP <br />FIRE SPRINKI <br />PIIONE ST�TE <br />STATE �ICENSE � <br />HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br />CON7AL10ERSONANOPNONENO . i � , _ . , <br />�gZ -� ��d <br />I HEREBY CERTIFY THAT 1 HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND (1RDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE ':OMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VI(.!.ATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOC4L LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CUNSTRUCTION. THAT I AM AUTNORIZED t7Y l HE <br />OWNER OF THIS FF RTY TO PERFORM THE WORK FOR WHICH <br />AFPLICATION I 1 COMPLY WITH THE STATE <br />CONTRACTO l CW D 296200 WAC. <br />x � l, �zf �l �- <br />SIGNATURE � U�TE <br />Cltt BUSIHESS LICENSC NO. <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />rv� — rvnnu�a <br />; � FORCED AIF S1 <br />� NEAT PUMP <br />i_ UNIT HEATERS <br />; CLOTHES DRYI <br />� RANGEHOOD <br />� N'ATER HEATER <br />� tVOOD STOVE <br />0 <br />INSERT <br />GAS <br />SUBTOTAL S <br />PERMIT E <br />TOTALfEE f <br />PUNCUECNNUMB[Il 'fEF IREf.EIPTNO <br />lO1�nEA VACANTSrtE rcc� <br />❑YES ❑ NO OUIIfIING <br />N00%OWELLING SIZEOFBIDGRI <br />UMf$ P111M01NG <br />OCCUPANiLO�D BASEMENT uEC11�NI�nI <br />❑YES ❑ NO <br />�DUIIIONGL PI�N CIIf.CN <br />REASON <br />p111Ef1 <br />RF�SQH <br />$1�1E �1111DWC.511f1C11�R0E <br />rinr�s�rrnoveoor CITYOFEVERE7T runiir,wO��S <br />LOCAL SALES <br />,,..� TAX CODE IS 3105 TOTAL <br />