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APPLICATIt��I FOR CONSTRUC7.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 59201 • 259-8810 <br />fl DEMOUTION fl COMBINATION I� BUILDING f 1 MECHANICAL r 1 PLUMBING fl SIGN <br />PROJECT ADDRESS <br />S�o� ('c.��,�=�� Pi��E. <br />OWNER M�ILADDRESS cm zir r��orue <br />..:Wic:N•. LEC.Hv�it ARuvt. y� :�3 <br />`S' -ri.'17 <br />7EN�NT MAILl�ODRF.SS CIIY 21� PIIONE <br />ARCMIiF.CT OR DESIGNER M�II. ��ORE55 �ITY 71P PMONF <br />PLUMBINGCONTR�CTdi M�IL�ODRE55 QtY 21P pHONE STATELICENSE� <br />OESCRIBE WOqK ANO SOU�RE FOOTAGE MVOIVED <br />� ._ �. _ _ _ " _ " _ ". . <br />PROPOSED USE OF BUILDINO <br />:�1 Ac_ - Ar..� [T: <br />LEGI�. DESCRIPiiO'� OF PRO'ER7Y �SIN <br />LOT _ ui,^,i.K __ <br />L�'-�.J � G�F � 3 � <br />S. S� e� � 3S <br />PNICELTAXIO MIMBEH <br />�//D2 -�YY _ ��� <br />corrsmucnon io�n oe , � es <br />PLUMBINO Na �� � <br />HO. TVPE OF FlXP <br />WATER CLOSET (TOIL <br />BATHTUB <br />UVATORY (WASH BA; <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISH�'�ASHER <br />UUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DNAIN <br />r+urneen <br />SUB TOTAL $ <br />PERMIT 5 <br />TOTAL FEE E <br />FOR OFFICE USE ONLY: <br />fRONTSFTP�CN � RFRp $FTBALR <br />Z� O� <br />USEZON IOLRRF� <br />_ —� O 2O O <br />HEIGIIT LIMIT�TION NO OF UWE!.LING <br />� � UNILS � <br />HEATING SYSTEM: f l GAS I 1 ELECTRfC f l <br />CONI�CT PF.RSON �NO �IIONF NO <br />I HEREBY CERTIFY THAT i HAVE READ AND EXAMINED TH�S <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT qLL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br />coaiEsl NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING GONSTRUCTION OR THE <br />� �. PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />X >_Z4._GS' <br />SIGNniORE OATE � <br />CIiV BUSMf:SS LICCNS[ N0. <br />MECHANICAL T�a,oc, <br />FEE NO, TYPE OF E <br />HNDLG UNITS — H.P. <br />AIR SYSTEMS — B.T.U. M E.A. <br />HEATERS — B.T.U. M <br />VENTILATION FAN <br />pAN6E HOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE ( <br />FIREPLACEINSERT <br />GAS FIREPLACc <br />GASRANGE <br />GAS PIPING <br />E%HAUSTFAN <br />SIDESELPA�N IPIAN <br />VRLANt SI1F <br />I�YES <br />$IZE O� 9LIX;41 <br />IlYES 11 NO <br />orr,orvsi ri.nasnrrnovennv CITYOFEVERETT <br />`II�' LOCAL SALES <br />�'IJ� onrE ,GS/.o /Sti TAl( CODE IS 3105 <br />13UIf 01NC. <br />PIIIINpMG <br />MFf,11ANICAL <br />RD�IIiONN. PI AN CNECK <br />otr�cn <br />STqI[ OIIIIJIHG SURGI�RCE <br />runur,wonKs <br />TOTAL <br />r[r <br />SUBTOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />(a. / O <br />�. U nFcnrrNo <br />� <br />FEE <br />