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0 <br />APPLIC�ATI�1 FOR CONSTRUC�N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION �./ <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />fl DEMOLITION (l COMBINATION I-1 BUILDING �i MECHANICAL � 1 PLUMBING f I SIGN <br />PROJECT ADDRESS <br />�J3�0 -� � /�✓e C� <br />ONTlER MAiLRD�R[55 ptY ZiP PHONE <br />�ic�,�� �a3 /�iv��� 9,��i asa- 9�a-�- <br />IERANT IANLRDDPf55 CITY IIP PIIONE <br />•RCHITECTORDESIGN[R MMI.A�pRE55 CiTY )iP PMONE <br />GENEPALCONiR�GTOR MA�IRWRE55 GLV J�P P�IONE SIAi[IICCNSE� <br />Mult ADDRE55 <br />CONTRRCT FRIGE Of WpRN <br />OESCRIBE WORK �NO SOWRE FOOTRGE I4VpLVEO <br />raaroseo u oF emioi c <br />�,S �[ G:� <br />LEG�L DESCRI{'TION OF PROPERiY ISMJWN <br />l0T BLOCN <br />Oq RT7ACN <br />CONSiAUCTION IO�N LENDEN. �DlME55. TEILPHONE NUMBEP <br />NO. TVPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BA?HTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KIiCHEN SINK 8 DISP <br />DI�HWASHER <br />LAUNDRYTPAY <br />CLOTHES WASHER <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTAL FEE $ <br />FOR OFFII:E USE ONIY: <br />(RONi S[TFInCN R[eq SFT(IACK $IDE SETOnLN <br />US[ ZOIJf <br />HEIGIIT 4MIiPTiON <br />iorenen <br />NO OF pWELLING <br />IINIi$ <br />nv <br />i�110NE STPTE IiCENSE � <br />ZIP PIIONE STATE �ICENSE � <br />HEATING SYSTEM: I I GAS f 1 ELECTRIC fl <br />CONTnCI FF.fi50N �.D {'MON[ NO ,� <br />/ / <br />(. _ �.e9� � y;i 3 .' �S� <br />1 HERE Y CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOR;( WILL BE COMPLIED WITH WHETHER SPECIFIE� HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOFS 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 />PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY 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 �—� �'C'1lo <br />SICNRTURF DAiB <br />CIiV �USIN[551 �CENS[ NO <br />MECHANICAL <br />FEE NO. TYPE OF EQUIPMENT FEE <br />w�.—rvnrvuw urviia—n.r. <br />FORCED AIR SYSTEMS — B.T.U. M <br />HEAT PUMP <br />UNIT HEATEPS — B.T.U. M <br />VENTILATION FAN <br />RANGEHO00 <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE i <br />FIREPLACEINSERT <br />GAS FIREPIACE <br />GASfiANGE <br />G�S PIPING <br />EXHAUSTFAN <br />SUD TOTAL 5 <br />PERMIT 5 <br />TOTAI FEE 5 <br />rinNci�ecKr+uunrn Ircr �nEr.FmrNo <br />VPCRNf SIIF. FEES <br />nves ���+o ounoir�c <br />42E Of BIOGrtI - <br />PLUM�ING <br />BAGENIENT MECNANICAI <br />�I�'ES II NO <br />�DDI1104�L PL AY CH(CK <br />OLH[R /. <br />!L <br />STAIEOUIIpING 1RCNAI <br />CITYOFEVERETT rumicwonKs <br />LOCALSALES <br />;. TAX CODE IS 3105 TOTAL <br />—' - <br />