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APPLICATI(.�J FOR CONSTRUC7 JN �ERMJ!'T <br />CITY OF EVERETT • BUILDING DIV(SION � <br />3200 CEDAR STREET • EVERETT, WA 982U1 • 259•8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUI�DING � ❑ MEnCHANICAL ❑ PLUMBING ❑ SIGN <br />PRO� ECT ADDRESS: f%/Lo ��C_� �%GI/LL'Ytl � 1/./0,[t l i(li} J <br />o`�/i: ,. J.�._ 1MT.. , ./ ... � '70// .G� .�/,...�rf' �'. �- !iL'?/7/ �%t,'P� �i��..�n <br />PRONE <br />PIIONE $IATEUCE�ISE• <br />MECNANICQCONTMLTOR MAILA�URE55 CIiY ZIP PIIONE STATEUCENSE� <br />PIUMBINCCONTR�CTOR MAIU006E55 CIIY IIP PHONE STATELICENSE� <br />CONTMCT PPoCE OF WOi1N <br />OESCPoBE WOPK �NO SOUAiIE <br />%�1 <br />PPOPOSE SE OFBUILDINO <br />LEWLOE � TIONOiPROPI <br />l07 eIOCK <br />7O �� <br />wvaveo <br />BEIOW pi �TTAL11 TNYI <br />PARLELTA%I.D.NUMBEN <br />/.'`�%�'-_7 —�-c_�/°��—..�ic'G� <br />CONSTRUCTION lON! IENDER,ADD�E55. TELEPHONE NUMBER <br />TYPE OF FlXTU <br />WATER CLOSET(TOILE <br />BATHTUB <br />LAVATORY(WASH BA�II <br />SHOWER <br />KITCHEN SINK 3 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHEFi <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTE <br />SINK (SERVICE — BAR, <br />PERA!IT S <br />TOTALFEE E <br />FOR OFFICE USE ONLY: <br />FRONT SETOACN REAR SETBACN SIOE SE78�CH <br />USE ZONE <br />HE1611T LIMITATION <br />FIRE AIMM PEO'D <br />....� y ..� <br />/�� �/��. �i� <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONi�CT PCf150N �Nf7 PHONE NO <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE THUE AND CORRECT ALl <br />PHOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYf'E Of' <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIEU IIEREIN OFl <br />NOT. THE ORANTING OF A?ERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATF <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />/ , /'�`� —, �>�— <br />S�`f.L�l— �—G _ <br />I N�TURE/ D�TE <br />pTY BUSINE55 UCE65E NO <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT <br />NC — A/HNDLG UNRS <br />FORCED Aifl SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTNES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />MEfAL FIREPLACE (WOOD BUR� <br />FIREPLACE INSERT (WOOD BURI <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />SUB TOTAL f <br />PERMIT S <br />TOTALFEE S <br />PlANC11CCRNUMp[O �EF �(CEIPTNO <br />..r2F/ /_ L�// 3'L <br />LOI�PEA VACAHISIIE rtta <br />❑YES ❑ NO pUIl01NG <br />NO OF OWELLIN6 512E OF 9lOGR1 � <br />UNII$ �� plUA101NC <br />� <br />33 <br />E�csrG. <br />as errnoven or <br />. /i� <br />e �—On-q� <br />4. �[. V�. �I <br />�SEMEN7 AIECM�NIC�I <br />❑YES �NO <br />eonmoruei. ru� r.uccK <br />omen <br />Si.V C OURnINb SIlOcll�nf.E <br />CI?YOFEYERETT runiir,wonKs <br />LOCAL SALES — <br />TAX COOE IS 3105 7oiAL <br />f� i _ _/.r _ �/`/ . _ <br />FEE <br />