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APPLICATI.,N FOR CONSTRUC 70N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION <br />PROJECT ADDRESS: _ _ -� �I� <br />❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />IIRCHITECTORDESIGNER MMlA00RE55 GITY 7i� ��10NE <br />GENEP�ICONTfiACTO{i MAILAUDOE55 C11Y I�P PIIONE $UTEUCENSE� <br />MECN�NICA�CONIR�LTO� MAIIADDRF.55 CITY ZiP P��ONE STATEUCENSE� <br />GlUM01NGCONTRACTOii M�ILAODPE55 GfY I�P PNONE STA7EL�CENSE� <br />CONTMGT PPILE OF VIORK �V` <br />--�'-�J <br />OESCRIBE WORK ANO SOU�RE ipOTAGE INVOlVEO <br />1 i / <br />�i�j'/�/ �/�' �/1%�i�/u(�- ,� l <br />{� <br />PROPOSEP VSE OF BUILDING <br />IEG�I DESCRIPTION OF PROPEPtt ISNOwN BELOW OR AiTAGN TVO COFIES� <br />LOT _ BLOG`c OF <br />PAHCELTA%I.D.NUMB.R <br />CONSTRVCTONLO/u1LEN0ER.ADORESS.TEIEPNONENUMBER <br />PLUMBING <br />NO. TVPE OF FlXTURE Ori ITEM FEE <br />WATER CLOSET (TOILET) ' <br />BATHTUB � <br />LAVATORY (WASH BASIN) � <br />SHOWER � <br />� <br />KITCHEN SINK 8 DISP _ � <br />IAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />— BAR, <br />SUB TOTAL S i <br />PEFlMIT S <br />�— - TOTP.I. FEE S � ' <br />FOR OFFICE USE ONLY: <br />FRONT SETflACN AEM SF.TOACN S�DE ScTBACN <br />USEIONE IOT�REA VACANISILE <br />OYE$ ❑ NO <br />HEIGHTUMITITION UNi OP OWEILING 512E OF BIW/I.i <br />HEO'D <br />[YES ❑ NO <br />CITY O�° EVERETT <br />LUCAL SALE� <br />TAx conE is aias <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACT PCRSONANO PNONE 40 <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TC BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TYPE OF <br />WORK WIIL BE COMPlIEO WITH WH�THER SPEC�fIEO HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR TNE <br />PERFORMANr.E OF CONSTRUCTION. THAT I AM AU7HOR¢ED BY THE <br />OWNER OF THIS PROPERTY TO PERFOHM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1B27 RCW AND 296.200 WAC. <br />x �0 /l% "��J <br />SIGN�TURE D�TE <br />qTY BUSINE55 UCENS[ NO <br />NO. TYPE OF ECUIPMENT � FE[ <br />rv� — rvrn�vw ��� <br />FORCED AIR SYSTI <br />HEAT PUMP <br />UNIT NEATERS <br />CLOTHES DRYERS <br />WATER HEATER <br />WOOD STOVE <br />MEfAL FIREPLACE � <br />FIREPLACE INSERT <br />GAS FIREPIAC <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL f <br />PERMIT S <br />TOTALFEE S <br />rur+c�iccKNuuncn �rep IneceirtNo <br />OlIIl01NC <br />PI UMpINO <br />MFC�UNICAL <br />RUU���ON�t PUN CIIGCK <br />on�cn <br />sum nunoi�c sunc�unce <br />runi ir, wonKs <br />TO'�AL <br />— � ---- � `� S'ti <br />