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APPLICATIt..� FOR CONSTRl1C7.dN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />CI DEMOLITION I� COMBINATION I� DUILDING f 1 MECHANICAL f l PLUMBING f� SIGN <br />PROJECT ADD[�ESS <br />3 11(� <br />'-1-c.rs v r1 = <br />� <br />GENEROLCONiRACiOR <br />Ile� (�ve ��e;e�'��- <br />cm zir VHONE <br />C-ueYp i-i� ZSZ O <br />CIIY ZIP PHONE <br />MAILFDORE55 ,I CITV ZIP <br />1�,, M es 1'-1 b a�f 6'7- P! w. L rl r�t . G <br />_ 7ys-34zs- aPe,u <br />P1104G STATE LICENSE • <br />MECHANIGILCONTRACTOl1 61FIL�DORE55 CITY IIP PIIOt�E STATEUCENSE+ <br />PLUMBINGCONTRACTOR MNLADL`RESS CIfY ZIP PHONE STATEUGENSE� <br />Ah� SOUARE FOOTAGE INVOLVED <br />PROPQSEO USE OF BUIlOI yG <br />L4w 0�-�,�ces <br />LEGAL OESCRIPTION OF PRCPERTY (SHOWN AF.LOW Oq ATfACM TWO GOPIES) <br />�or '�2`� e�oc�<�`�cr rve.re�"'E' <br />PARCEI. TA% IA. NUh1BER <br />LI391- �3�-oz`f-oopG <br />CONSTRUCTIONLOANLENDER.AD�RG55.T[LEPHONENUMBER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />SHOWER <br />KITCHEN SINK 8 DISP <br />�AUNDRYTFAY <br />CLOTHES WASHER <br />DR� �KING FOUNTAIN <br />FLOOR ORAIN <br />SINK (SERVICE — BAR, <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK PF.AR SEiPACK <br />JSEZONE <br />IIEIGHT LIMIiATON <br />OCCUPANCV NO OF <br />GROUP <br />FIRE PLARM REO'D <br />SUB TOTAL 5 � <br />PEFiM1T S � <br />TOTALFEE S _y <br />SIDE SEIDACK <br />IOTAREA <br />NO. OF UWELLIRG <br />UNITS <br />OCWPANi LO�� <br />REA50Y <br />RE�SON <br />PLAN fy'fi0YE0 <br />�,�ti� <br />/� <br />onrE �-i,7' <br />VFC�Nt SITC <br />�7YE5 fl NO <br />5'Z[ OF �IDG/fl. <br />BASEMENT <br />fIYES fl NO <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />HEATING SYSTEM: fl GAS fl ELECTRIC ❑ <br />CONTACT PEpSON AN� PHONE NO. <br />I3 � ��e s�. �-� y �� 3�1 zs <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TH'S <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. A.L <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING TF"S TYPE O� <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED NEREIN 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 REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THA7 I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEFiTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLI' WITH THE STATE <br />CONTR CTORS LAW 18.27 RCW AND 296.200 WAC. <br />x � <br />SIG ATUiiE 0 TE <br />QTV BUSWESS LICENSE NO. <br />MECHANICAL <br />NO. TYPE OF FIXTURE 0.31TEM FEE <br />A!C — A/HNDLG UNITS — H.I'. � <br />FORCED AIR SYSTEMS — B.1 U. M E.A. ; <br />HEAT PUMP i <br />UNIT HEATERS — B.T.U. M ' <br />CLOTHES DRVERS � <br />T <br />VENTILATION FAN � <br />RANGEHOOD i <br />WATER HEATER � <br />WOODSTOVE ' <br />METAL FIHEPLACE (WOOD flURNING) i <br />FIREPLACE INSERT (WOOD BURNINf) � <br />�— <br />GAS FIREPLACE ' <br />GAS RANGE � <br />GAS PIPING � <br />EXHAUSTPAN � <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE 5 <br />PtAN CHECN Nl�/pER I iEE I RECEIPT N0. <br />�111LDING <br />PLl1A:01NG <br />1,1EGIIFNICAL <br />AU01➢ON�L PLAN CHECK <br />0�11EB i <br />-i - <br />SiATEDUItDINGSURCHFRGE � ' <br />L !_ <br />_ --�- <br />� <br />PUBLIC WORKS � <br />TOTAL �j,- ��U <br />