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APPE.ICATIOt� FOR CONSTI;UGTIL .H P�RMITr <br /> CITY OF EVERETT•BUILDING DIVISION G� <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 � <br /> f] DEMOLITION fl COMBINATION f, BUILDING MECHANICAL fl PLUMBING f� SIGN <br /> PROJECT ADDRESS ' I /� \ <br /> �JZ V iCr,.� f`, i ./� • �i�C' i %x��, <br /> �%�vl✓ f��arJ �� Z5�- M�nvb��� �P� � Z��JC��HONE ��7 - �SICo - <br /> TENANT MNLADDHE55 GTY 21P PHONE <br /> AHCMITECTORDESIGNER MAILADDflE55 LITY 21P PMONE <br /> GENEMLCANTMGTOR MNL/�WRESS CIiY ZIP PHONE SiA1EULENSE� <br /> MECN/NIICALCONTAALTOR MNIADDflE55 CIfY 21P PHONE STATEUGENSE� <br /> �`�� <br /> PLUMBINGCONTRK!OR MNLI�WRESS CIiY 21P PNONE STAIEIlGENSE� <br /> C TMLT PRICE OF WORK <br /> � �7CG.� HEATING SYSTEM.: �GAS ❑ELECTRIC I7 <br /> DESCRIBE VIORR AND 90UME FOOT�GE W VOLVED CONT�CT P[NSON AND PHON_N0. � <br /> .�oe ��Z-�ll <br /> '7%�GC h G� itiPT <br /> �U��PrC� . ��✓� � t7fJ"C �U-�T I HEREBY CERTIFY ?HAT I HAVE READ AND EXAMINED THIS <br /> APPL�CATION AND KNOW THE SAME TO BE TRUE AND CORHECT.ALL <br /> PROPOSEDUSE OF BUII PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE JF <br /> WORK WILL BE COMPLIED WITH WHETMER SPECIFIED IIEREIN OR <br /> LEOALDESCRIPTIONOFGROPERtt�SHOWHtlELOWOR�T7ACNTWOCOPIES) NOT. THE GRAN7ING OF A PERMIT DOES NOT PRESUME TO GrvE <br /> �or etocK oF AUTHORITY TO VIOLATE OR CANCEL TNE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TME <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTMORIZED BY TNE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WMICIi <br /> APPIICATION IS MADE AND I COMPLY WITH TME STATE <br /> PMCELTAII I.U.NUMBER CONTRACTORS LAW 1827 RCW AND 286200 WAC. <br /> LONSTRUCPONLON/tENOER,ADDPESS.TELEPHONENUMBER x . 5 �' � `����5 <br /> SI / RE D�TE <br /> qTY BU9NESS IIGENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI%TURE OR ITEM FEE NO. TYPE OF FI%TURE OR ITEM FEE <br /> WATERCLOSET�TOILET) � !VC—A/HNDLGUNITS—H.P. <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. <br /> LAVATORY(WASH BASIN) i HEAT PUMP <br /> SHOWER ' UNITHEATERS—B.T.U. M <br /> KITCHEN SINK 8 DISP i CLOTMES DRYERS i <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRYTRAY ; RANGEHOOD ' <br /> CLOTHES WASHER � WATER HEATER <br /> UR'NAL WOOD STOVE , <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING` <br /> FLOOR DRAIN � FIREPLAGE�NSERT(WOOD BURNING) <br /> BACKFLOW PREVENTERS i <br /> GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC,) � GAS RANGE ' <br /> � GAS PIPING � <br /> i EXHAUSTFAN � <br /> . � i <br /> _ � i <br /> -- i <br /> � <br /> S118 TOTAL E ' SUB TOTAL S ' <br /> PERMIT S i PERMIT S <br /> TOTAIFEE E � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK NEM SETBACK SIDE SETBACN PU1+p�CCK UMBEft^ FEE RkGEiPT NO. <br /> ����i <br /> usEzoNe �oina� wceruisrtc FEES VAWATION FEE <br /> ['IYES fl NO BUILDING i <br /> MEIOMTL1MIiAT10N NOOF�WELUNO SIZEOFBLIX'Jf.l. �— <br /> UNIT$ PLUMBING <br /> �� <br /> OCCUPANCY NO.Of510ftlE5 OCCUPMlTlOA� 6ASEMENT MECMGNICAL I <br /> �RWP ❑YES ❑ NO I <br /> — nuUITIONf "'°YCHECK � <br /> FIREAUFMflEO'D REASON <br /> i <br /> . � <br /> OiHER <br /> i <br /> FIRE SPPINKLEH REO'D R[ASON <br /> STATEBW�. >URCHAqGE � <br /> � <br /> � <br /> TYPEOFCONST. PUNSMPNOVEDBY CITYOFEyERE7T PUBUCWOPr <br /> LOCALSALES I <br /> onre TAX CODE IS 3105 TOTAL ' <br />