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APPLICATI�..� FOR COI�OSTRUC7..�N PERMIT <br />CITY OF EVERETT • BUILOING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOUTION ❑ COINBINATION ❑ BUILDINGn DQ MECHANICAL ❑ PLUMBING p SIGN <br />PROJECT ADDRESS: ����D� I'�C i( ft � �, Q� l A A) Sl.. _ <br />IENANT uui woacss r,nr tm rnoNc <br />11RCMTECT ql DESIGNEF M�1: MINiE55 GTY )n+ P110NF <br />CENER/�ICONiR�CTOR M�IL�DDRESS f.IIY 7�� P�IONE GUiELICENSE• <br />MUMBINC CONTR�CTOR <br />CONTMCT PRICE OF W JRK <br />lOT BLOCK <br />M111L <br />M�II <br />BELOW p1 �TfI�LN TWO COPIES� <br />CONSTRUCTION IONI LENDER. AOOHESS. TEIEPHONE MIMBER <br />�� PLUMBINO <br />t NO. TYPE OF flXTURE OR ITEM FEE <br />' WATER CLOSET (TOILET) � <br />BATMTUB ; <br />UVATORV (WASH BASIN) � <br />SHOWER <br />KITCHEN SINK 8 DISP � <br />DISHWASHER � <br />UUNDRV TRAY ; <br />CLOTHES WASHER � <br />URINAL ' <br />DRINKING FOUNTAIN <br />FIOOR DHAIN ' <br />BACKFLOW PREVENTERS ; <br />SINK (SERVICE — BAR, ETC.) � <br />SUB TOTAL S <br />PERMIT S <br />TOl'AL fEE S <br />FOR OFFICE USE ONLV: <br />FRONT SETB�CN RE�R $FTBALN 90E SETB�CN <br />ME�GHi UMITATION <br />REO'D <br />TYPE <br />7�P PIION[ STQQlCENSE / <br />71P � PNONE STAiE UCENSE • <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC � <br />CONT�CI Pf RSON At1� PNONE NO <br />I HEREBY CERTIFV THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF IAWS AND ORDINANCES GOVEHNING THIS TYPE OF <br />WORK W�LL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AIiTHORITY TO VIOLATE OR CANCEL THE PROYISION OF ANY <br />OTHER STATE OR LOCAL I.AW RECaULATING CONSTHUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />X ��,n�P� � o,�- <br />SIGN�iVRE ^^, / D�TE <br />C JGCl�� �1 <br />pTY BUSINFSS IICENSE NO <br />NO. I TYPE OF EOUIPMENT I FEE <br />rvv — rvnnvw um � a <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />CLOTHES DRYER5 <br />RANGEHOOD <br />WOOD STOVE <br />METAL FIREPLACE <br />GqS FIREPLACE <br />GAS i7ANGC <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL S <br />PERMIT E <br />TOTAI. FE� E <br />rt�r+cri�cKr+uunen � r[r � RFc.F�rt r+o <br />lOiAnE� v�G�NI511E rceo <br />❑YES 0 NO pUIL�INfs <br />NO OF DN'EILING 512E OF BLOGRI � <br />UNI'S PlUlAOiNG <br />OCCUPANTLO�D d�SEMENT uFC1uNiCn1 <br />❑vE5 ❑ HO ----- <br />RF�SON ADD�IIONPI �`I �N CIII.Gk <br />nmEn <br />RE�Sp� <br />Si41C f111111��Nf.SUhf.H�ROC <br />rinvserrnovenor CITYOFEVERETT runncwonKc <br />LOCALSALES -- <br />,,,,� TAX CODE IS 3105 TOTAL <br />