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APPLICATIOrI FOR CONSTRUCT�ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />� DEMOUTION f 1 COMBINATION I� BUILDING f� MECHANICAL r l PLUMBING f 1 SIGN <br />PROJECT ADDRESS <br />��i.�,�.U�1, <br />- <br />CITV <br />21P <br />�.""8�3f <br />AAGNITECTORDESIGNER MRIIADDPE55 CITV ]IP PNONE <br />GENER/LCONiRACIOq MAILAU�RES$ CIIY 71P PIIOYE SiATEUCGNSF� <br />NECHANICALCONTRACTOR MAILADDRE55 CIN 21P PHONE STAiELICF.NSE� <br />PWMBINGCONTRACTOR MAILADORE55 CItY IIP PHONE STAiGLICENSE� <br />or <br />DESCRIBE WJRN AND SOUARE FOpTAGE INVOIVED <br />17�� /� <br />USE OF <br />�tG�L OES2CflIPTION OF PROPERtt (SNOWN BELOW OR RTfACN <br />LOT ,�J_ BLOCK in ��n pF ��% <br />�' <br />'�"� �`i " l0(�O �c�i�" <br />GONSTRUCTION LOAN IENDER. AUpRESS. TELE�'MONE NVNBER <br />N� TYPE OF flXTURE OR ITEM <br />WA1�ER CLOSET (TOILETI <br />LAVATORY(WASH BA; <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ET <br />PERMIT 5 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />fRONT SETPAGK PEAq SFTBACN <br />USEZONE IOLAREA <br />�_� � <br />HEIGIIT UMITATION NO OF UWEILING <br />OGCUPPNCV I NO 0! <br />cnour <br />IYPE OF f.��NSt <br />i// // <br />FEE <br />SIOE SETB/•CK <br />VAf,pNf SIIF <br />IIVES fl NO <br />size oF aiocrti <br />BASEMENt <br />IttES iiNO <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />HEATING SYSTEM: I l GAS f-1 ELECTRIC (l <br />CONT/�'f PERSON ANO PJ/ONE Np, <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINE� 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 NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROV�SION OF ANY <br />OTHER STATE OR LOCAI. LAW REGULATING CONSTRUCTION OR THE <br />PEFFORMANCE OF CONSTRUCTION. THA7 I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY W�TH THE STATE <br />CONTRACTORS LAW 1027 RCW D 9 00 � <br />x� <br />SIGNATURE p7� <br />CITV BUSIYE55 LICENSE N0. <br />NO. � TVPE OP EOUIPMENT � FEE <br />A/C — A/FiNDLG 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 DRVEFS <br />VENTILATION FAN <br />RANGEHOOD <br />WOODSTOVE <br />M'cTAL FIREPLACE <br />fIREPLACE INSER' <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />PIAVCIIECKNUMpfti fEF <br />FEES <br />�UILDMf. <br />vwuniNc <br />MFf.11nNiCAI <br />nDD�IICNnL PLAN C��f.CK <br />O1NGR <br />STAI[ 9l1IlDIN(1 SUfiGHAq(iE <br />ru8t ir, worKs <br />TOTAL <br />SUB TO7AL $ <br />PERMIT $ <br />RECEIPT NO <br />