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APPLICATIGA FOR CONSTRUC'f .OI�! PERMIT� <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />fl DEMOLITION f 1 COMBINATION fl BUILDING �i MECHANICAL i � PLUMBING fl SIGN <br />�///07 3'��'�c SE �v��it 9�Zog � <br />OWNER MRiLRGdRESS Cltt ZiP PNON[ <br />,�jyv'4 �E�4��S IIIQ7 3e-`� �i SE �vFK� �',�ZU�' x� 3�%7 ZLZ� <br />IENANT MRILADORF55 GItV 21P PNONE <br />MGHITECT OR DESIGN[R <br />7iP PHO4F <br />GENERAlCON1MCtOR MRILAD�RESS CILV IIP f'I�OAC SLAlE11CFN5E• <br />MECIUNICALCONIRACjOfI MAILADDRE55 GTV 7R' PNONE STATF.UC[NSE� <br />IEGRL <br />LOT _ <br />PND SOU/RE FOOTAGE INVOIVED <br />����4 . ___ �7� <br />BLOCN <br />PARCELTA%ID.NlIMBER <br />CONSTIiUCIION IORN 1 ENOER. AODRE55. TELEPHONE NUMBEfi <br />PLUMBING <br />NO. TYPE OF FI%TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />�ISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. Ei <br />TWD COPIES� <br />SUBTOTAL 5 <br />PERMIT S <br />TOTALFEE 5 <br />FOR OFFICE USE ONLY: <br />ff10NTSFTpACK REARSFIDACN SIDESETBACN <br />USE 20N[ <br />HEIGIIT LIMITATION <br />OCCUFTNCY NO Oi $11 <br />GROUP <br />fIBE !�! Aflu �E00 <br />FlI1F SPRINNI ER R(:O fl <br />i m �nen <br />NO OF UWEILING <br />UNILS <br />UAIE <br />V�CRNI SItE <br />f�vES I1 NU <br />512[ Of 9lIX:T <br />It�ES ��NO <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />21P fHONE STAiELICFNSF• <br />HEATING SYSTEM: I� GAS rl ELECTRIC f i <br />cor+lncr rensarv nrvo ruorvE ruo <br />I HEREBY CERTIFY THAT 1 HAVE READ �ND EXAMIN[D THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE CUMPLIED WITH WHETHER SPECIFIEU HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MAOE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />x `?�t�'� L__-_`v- lo� � <br />SIGHAIURE DAIC: <br />CITY EIUSINES$ LICENSC NO <br />MECHANICAL <br />NO. TYPE OF EGUIPMENT FEE <br />A/C — A/HNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — �.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT (WOOD BURNING) <br />GAS FIREPLACE <br />GASRANGE <br />GAS FIPING � <br />EXHAUSTFAN <br />)TAL 5 <br />f 5 <br />FEE 5 <br />rinNc�mcKNun+nrn �rrc �nccrirrno <br />Ol1ilDING <br />i <br />f UINHING � <br />� <br />lJPCIIANICAI � <br />I <br />__ _ _ 1 <br />Af1D111pNAL PI A4 CI�fCK � <br />— �— <br />OIHER <br />STAI[ OUiIOMG SUfiCH�RGE <br />PIIPI If, WOPKS <br />iOTAL � <br />1—_ _ <br />