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-• ,:� <br />� APPLICATIV.�1 FOR CONSTRUCI �ON P�RMIT/ <br />CITY OF EVERETT • BUILDING DIVISION L�C���� <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 � <br />❑ DEMOUTION f l COWBINATION f� BUILDING I-1 MECHANICAL rl PLUMBING (� SIGN <br />PROJECT ADDRESS _ . , � _ _ _ . <br />� <br />MML <br />�� <br />zm <br />1'MONE <br />r <br />GENEAALCONTA4CTOR MRILADDRE55 CITY IiP PHONE STATEUCENSE� <br />MECHANIC�f.CONTRACiOP MAIIADDRE55 CIN IIP PHONE ST�TELILENSEI <br />PLUMBINGCONTR�CTqi NAILADDRES$ CI7Y ZIP PNONE $i�TELICENSE� <br />CONTRACT <br />DESCRIBE YIJRK <br />� /f. �� <br />o L' <br />INVO:.VED <br />IEOAI DESCAIPTION OF PROPERTY (SHONM BELOW OR �TfACH TWO COPIES� <br />LOT BLOCK OF <br />TA% I.D. NUMBER <br />CONSiRUCTON LOAN LENOEF, �DORE55, IELEPMONE NUMBER <br />FEE <br />WATER GLOSET <br />BATHTUB <br />LAVATORV(WAS <br />SHOWER <br />KITCHEN SINK 8 <br />BACKFLOW PREVENTERS ; <br />SINK (SER\'ICE — BAR, ETC.) � <br />i <br />� <br />SUB TOTAL � ; <br />PERMIT $ � <br />TOTAL FEE $ � <br />FOR OFFICE USE ONLY: <br />FpONT SE7BACK RF.AR SETMCK SIDE SETBACN <br />USEZONE I LOTAREA <br />NEIOHTLINIT�TION NO.OFDWELLING <br />UNITS <br />OCCUPANCY NO OF Si0PIE5 OCCI'PANT LOAD <br />GROUP <br />1'IRE AURM REO'D <br />DATE <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC I l <br />CONTACT PERSON �ND i'HONE N0. <br />I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CARRECT. AlL <br />PROVISIONS OF LAWS AND OR(�INANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFiED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CAI�CEL THE PROVISION OF ANY <br />OTHER 51ATE OR LOCAL LAW REGULATIDJO CONSTRUCTION OR THE <br />PERFORMANCE OF COIJSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS pROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTR TORS LAW 1.27 RCW �D 296200 WAC. <br />� � ��' 6/y� <br />X r <br />SIGN�TURE D E <br />CITY 6USINE55 LICENSE NO. <br />MECHANICAL <br />NO. TYPE OF FlXTURE OR ITEM FEE <br />A/C — NFiNDLG UNITS — H.P. �— <br />F(1RCFf1 AIR RVSTF/�AR — R T I I 1.1 F A ! <br />OcAA��S <br />(WOOD <br />GAS RANGE <br />GAS PIPING <br />E%HAUSTFAN <br />SUBTOTAL $ <br />PL/NCHECKNUAIDER �°EE IRECEIPiNO. <br />I VpCpriVESE fi NO I— <br />991LDING <br />SIZE OF BLOGR I. <br />PWMpING <br />BRSEMEN-i MECNANICAI <br />❑YES ft NO <br />AODIt10NA1. PLAN CNECK <br />OTHEF <br />STATE DUILDING SURCHARGE <br />CITY OF EVERETT ruouc wonKs <br />LOCALSALES <br />TAX CODE IS 3105 70TA� <br />