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APPLICA�TI�.r�l FOR CONSTRUC7.ON PERMIT� <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEQAR STREET • EVERETT, WA 98201 • 259-8810 <br />fl DEMOLITION fl COMBINATION I-1 BUILDING I� MECHANICAL i 1 PLUMBING fl SIGN <br />PROJECT ADDRESS <br />yy.� � s�- 3s.q�< <br />py�Eq MhIL�DDPE55 Lltt IIP f'NONE <br />G�/«i� /h�C�«c..�Y ,29,Z� ��.>JY ��i��i�� r�'�G'/ 2 �'-7ioi <br />TE�ANT MAILADDRE55 QiY l�P i'�IONE <br />ARGNITCGT OR OESIGN[il MNI. AODRE55 CIIY liP PIIONE <br />GENEMLCONiMG10R MAILADIl0E55 CIIV 7�� PiIONE StRT[LICENSE� <br />MECH�NIC�I CONiRRCTOR M��L �DORF.55 Cltt 71t` PHONE SiRtE L�CENSE • <br />�Yryirirai 7i .1�.,}T.�J.+��L l.///C %l�'✓/✓� !:Elv��i' �.�0/ v� ���/ �ic�."�54i,�/.�J <br />_..........,.....�..,.�...o uu�erviaccC CITY ZIN PHONE $TAfEUCENSE� <br />WO{iK AND SOU�RE FOOTAfE INVOLYEO <br />P{qPO5E0 USE OF pUIlpN3 <br />l ,//v� E�G <br />LEG�I DE!�CP�P710N Of PRO�ERTY (SNOYM BELOW (.:� �n�CM 7 WO GOPIES) <br />ior eiocK or <br />C.(INSTRUGTION LOIW LENDER. ADDNE55. TEIEPHONE NUMAEfi <br />PLUMBIN6 ' <br />NO. TYPE OF FlI(TURE OR ITEM <br />WATER CLOSET (TOI�ET) <br />BATHTi iB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />LAUNDRV TRAY <br />SUBTOTAL <br />FEE <br />HEATING SYSTEM: �GAS �l ELECTRIC I-1 <br />CONT�CiPER50NANOfHONEND .� � ,� � <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPL�CATION AND KNOW THE SAME TO OE TRUE AND CORRECT ALL <br />PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HER[IIJ f` i <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STl.TE OR LOCAL LAW REGULATIIJG CONSTHUCTION OR THE <br />PERFORMANCE OF CGNSTRUCTION. THAT i AM AUTNORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACT LAW iB27 RCW AND 296200 WAC. <br />X SL���`� /n-�7-%� <br />SIGNATIIRE D4TE <br />dT1 �iU5MES5 LICENS@ NO. <br />MECHANICAL <br />FEE NO. TYPE OF ECUIPMENT <br />�— A/C—AIHNDLGUNITS--H.P. <br />—� FORCEDAIRSVSTEMS—B.T.U. <br />� HEAT PUMf' <br />� � UNIT HEATERS — �.i.U. M <br />� � CLOTHES DRYEHS <br />� VENTILATION FAN <br />FOR OFrICE USE ONLY: <br />fPONTGF.Tp�qN RG��SFTBACK SIDESETA�f.N <br />IISE iONE <br />IIEIGHT LiMIT�PON <br />OCCUP�NCV NO 01 <br />cnour <br />FlRE M�P�A f1EQ D <br />LpT MEA <br />NO OF OWELIING <br />IINIIS <br />OCCUPRNiLORD <br />RfASON <br />FE�SfFI <br />r�nNs �rrnoveo ov <br />UniF. <br />� <br />AANGEHOO� <br />N'ATEF HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT (WOOD BURNING) <br />GAS FIREPLACE <br />3ASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTA� $ <br />PERMIT S <br />TOTAL FEE 5 <br />.reuuunrn �FG RCCGIriNO <br />VACP111 $Iif <br />I t V[5 I 1 k0 BU�I�MC. <br />54E Of 91 �G� 1 <br />rmuni�+c <br />BRSEM[NI M[CIUNICAL <br />tIY[5 II NO <br />PDOit10NP1. �I AN Gllf CN <br />on¢n <br />sinie nwinn+r. suncrinnce <br />C�TYOFEVERETT �'umicwoi�Ks <br />LOCAL SALES <br />TAX CODE IS 3i05 TOl'AL <br />