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APPLICAT14.�1 FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 C:EDAR STREET • EVERETT, WA 98201 • 259-BB10 <br />f7 DEMOLITION f l COMBINATION f-1 BUILDING I-1 MECHANICAL �l pLUM81NG f-1 SION <br />AODRESS <br />vwnen MNLAOORESS cm z�r rr:or+E <br />�4'-i� �r��Hnr 462.� StF,1.�r5� �er 4�?�03 o3-OS 1/ <br />TEIUNT MIUL�DDRE55 CITY Zip i`IIONE <br />D��N�r� <br />�RCNITECTORDESIGNER M�t1.ADpRE55 L�TV ZiP P�IONE <br />��AUL � <br />GENERAICONiP�CiOR M�IIADDRE55 CIIY iiP PiIONC GUTELICENSE� <br />�NEr� <br />MECN�NICALCONiR�CTOq M�ILRUDRE55 f.ITV ZIP PIIONE SiATEIICENSF� <br />n`"/NQ 1" <br />PLUMBINGCONTRAf,1pi MAIL11ppRE55 GI1Y ZIP PIIONE STATELILENSE� <br />�� <br />INVOlVEO <br />/1) <br />�� a 1r Gl i�Y � <br />iec��oescmrnowovrao� <br />LOT BLOCK <br />--3-UU,i-vo� <br />ER. Mld1E55.lELEPHONE MIMBER <br />WATER CLOSET <br />BATHTUB <br />LAVATORY(WAS <br />SHOWER <br />KITCHEN SINK 3 <br />DISHWASMER <br />UUNDRY TAAV <br />CLOTHES WASH <br />URINAI <br />DRINKINO FOUN <br />ROOR ORAIN <br />BACKFLOW PRE <br />SINK (SERVICE - <br />HEATING SVSTEM: f 1 GAS �l ELECTRIC � 1 <br />GONTACT PFPSON �N� PIIONE NO <br />I HEREBV CERTIFV THAT 1 HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT AlL <br />PROVISIONS OF LAWS AND OROINANCES 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 GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAI lAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />x �i.t,�.� �Qi.�.�c� 7 �/ �f - t,1' <br />SIGNRTURE DQE <br />CITY BUSINE55 LICENSC Vp <br />MECN�NICAL <br />ITEM FEE N0. T'PE OF EOUIPMENT <br />A/C — AMNDLG UNITS — H.P. <br />; FORCED AIR SVSTEMS — A.T.U. M E.A. <br />SUB TOTAL E <br />PERMIT E <br />TOTALFEE 5 <br />FOR OFFICE USE ONLY: <br />fRONT SFTf1 N � RE�P SF.TP�CK SI�E SEiBPCN <br />o �5'b,,c�'°��, � ' <br />USE]ONE IOi�tiEA WC�N1511F <br />� 1 Ai(1.1 Ll.�� ��v[5 <br />– h� <br />NO OF OWEILING I SRE OP AIIX;rt� <br />UMtS <br />� <br />IO�D <br />Lp:I li:l �il i d��:i i�� �'. <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE <br />7_1.[H9 <br />PI��N"� E� NNIIMBFIi �fE <br />vn 751n ` <br />FEES <br />011l(DING <br />Pl11MfiMG <br />-""" I MPCIIANIC�L <br />IIYES W+� f <br />Al1DI110NA1 t'IAN C11fCN <br />O1�2R <br />S1qE OUIlDI4G SURf,II�R(:E <br />CITY OF EVERETT ruAnr. worKs <br />LOCALSALES <br />TAX CODE IS 3105 7o7A1 <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE S <br />R[f,f IPT NO <br />J �� <br />