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APPLICATit..� FOR CONSTRUCT�OI� PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8870 <br />❑ DEMOLITION C COMB�NATION ❑.BUILDINGn Cl MECIiANICAL � PLUMBING ❑ SIGN <br />_ , /1 n <br />1'110NE <br />ARCHRECTORDESIGNER M�IIADOnE55 GIIV ill' PuONE <br />GENEMICONTMLiOR M�IlAD011E55 GIY )II` PIIpN@ SGLEIICENSE� <br />MEC1!�HI�AlCON7RA�T0(1 M�IUDURE55 CIIY )II' � PIIONE STATEUCENSE� <br />l�Vv�vin�lN �i--, /��VWlC51�%l-, �✓�-V��J- ----- <br />PLUMBINGCONTRACTOR NLAODnE55 GIIY !m PIIONE STATEIICENSEi <br />CONTRACTPPoCEOF <br />OESCRIBE NORK ANO SOUARE FOpTAGE INVOLVED <br />tOT BLOCK <br />CONSTRUC710N 101w IENDER. AUURE55. fEIEPNONE NUMBEI7 <br />NO. I TYPE OF fl[TURE OR ITEM <br />BATHTUB <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />CIOTHES WASHER <br />ORINKING FOUNTAIN <br />BACKFLOW PREVENTERS <br />SUB TOTAL S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBA�N PE�IISFTO�CK S��ESEtB�CK <br />USEZONE <br />HEIGMT LIMITATION <br />OCGUPANCY 1!0 (% <br />GR� . <br />FlRE SPRINKLER flEC' <br />FIRE AIl�RM REO'D <br />11EATING SYSTEM: O GAS ❑ ELECTRIC ❑ <br />CONI�Cf Pf11501! �Nfl PIIONF. NO <br />I HEREOY CERTIFY THAT I HAVE READ AND EXAMINED TMiIS <br />APPLICA710N AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDIfJANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIE� HEREIN OR <br />NOT. TIiE (3RANTiNG OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTI-IOHITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REQULATING CONSTRUCTION OR THE <br />PERFOfiMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS TY TO PERFORM THE WORK FOR WHICH <br />APPLICATION MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS �AW 1027 CW ANp 255200 WAC. <br />� ' // <br />x — � L(�•v l- Z �l - �i <br />516NA� fIF. ORTE <br />CIIY OIISINES$ l ICENSE NO <br />MECHANICAL <br />FEE NO. TYPE OF <br />� A/C — MiNOLa U� <br />; POFlCED AIR SYSTI <br />� HEAT PUMP <br />� UNIT HEATERS <br />; CLOTHES DRVERS <br />� RANGEHOOD <br />; WATERfIEATER <br />� WOOD STOVE <br />� MFTAL FIREPLACE ( <br />; FIREPLACEINSERT <br />� GAS FIREPLACE <br />; GASRANGE <br />� GAS PIPING <br />; EXIIAUST FAN <br />PERMIT f <br />TOTALFEE f <br />PI�NCIICf.NN11A111f0 I fEF � �Ef.E1PiN0 <br />IOTAREA VACANTSI7G YttS <br />❑YE$ ❑ NO OUllf)MG <br />NOOFOWEIIING SZEOFBIOCRI ---- <br />UNIf$ P1111ApMf: <br />OCCUPrNi LOeD B�SEMENi MECIInHlf.nl <br />OrES ❑ NO '— — <br />�iFA$ON �DDIIIONAI PI �N CIII CN <br />OIIIEO '— <br />REnSqN <br />Si�ip pllllblil(: SUOCIInfIGE <br />vinNS�nnnovEoor CITYOFEVERETT runnr,wnnKs <br />LOCAL SALES -- ---- <br />o,,,E TAX CODE IS �105 7o7n� <br />