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APPLICATII.�N FOR CONSTRUCI iON PERM��T/ <br /> CITY OF EVERETT• BUILDING DIVISION VC�r�� <br /> 3200 CEDAR STREET • EVERETT, WA 98201 •259•8810 � ��tt <br /> fl DEMOLITION rl COMBINATIUN UILDING I l MECHANICAL r� p�UM81NG f l SIGN <br /> PROJECTiD RESS <br /> 'L�r.� ( � � <br /> E'� � �OLVy (i�Lr, citt z�r � riauc <br /> T �NT M�IL DDRESS • f.ILV ZiP f��ONE <br /> t��Isu,w�e r.¢�tvcr r�u.�s�it��n,�, <br /> �RC�M.T.EIGTORDE5IGNF.f1 MMI��DRE55 CITV )iP PHphF ^-' <br /> GENER�lC�flRCip{1 MpILADIXIE� �G��a����� �O T� �� ���0�' ^ <br /> CI1Y 71P p110N[ GfA1E lIC[NSE� <br /> NECNANIC�lCON7RACTOB M�pAJf:�E55 Cltt DP PIIONE STfTELICF.NSE� <br /> PIUMBINGCONIR�CiOq MAILADDPCSS �— CIiY ZIP PHONE SiATELICENSE� <br /> CONTRACT Fttl4E OF Wpf1N <br /> � O • HEATING SYSTEM: I l GAS f-1 ELECTRIC f"1 <br /> �E N NDSOWRE�OOT�GEINVOLVED ONTeCT�'EHSONANDPHONF <br /> S' � <br /> ��1U�(oA1 P t t01U o - p <br /> I HEREBV CEGiTIFV THAT I HAVE READ AND EXAMINED THIS <br /> vnoPoseo use oF eui�oirxi APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC7 ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEG�L CRIPTIpNpFpqppER WORK W'ILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> - , I (sH BELOwOR TTACNTWOCOPI NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or�BiaK or �% AUTHORITY SO VIOLATE OP CANCEL THE PROVISION OF ANY <br /> � l�r OTHER STAi E OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE <br /> PERFO�iMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWAcR OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS ADE ANO I COMPLY WITH THE STATE <br /> . E T�xiD re»ee�� � �'� � �O / CONTRACTOR AW RCW ID 96200WAC. <br /> \.Y I <br /> CONSTi1UCT10N IO�N IENDER.ADDRE55.TEIEPNONE NUMBEii X <br /> , — SIGN�iURE �Tf, <br /> CITY BUSME55 LICENSC NO. <br /> � P����� MECMANICAL <br /> NO. TVPE OF FlIITURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn A/C—AMNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> UVATORY(WASH BASIN) � HeA7 PUMP , <br /> SHOWER � UNITHEATERS--B.T.U. M <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS ; <br /> , DISHWAS-ER � VENTILATIONFAN <br /> LAUNDRV TRAY ; RANGE HO00 � <br /> CLOTHES WASHER WATER HEATER , <br /> URINAL WOOD STOVE � <br /> _ DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIFEPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAp,ETC.) � GAS NANGE <br /> ' GAS PIPING <br /> i EXHAUSTFAN � <br /> i � <br /> i � <br /> SUBTOTAL E � SUBTOTAL E ' <br /> i <br /> PERMIT $ � PERMIT $ � <br /> TOTAI FEE S � TOTAL FEE S � <br /> FOR OFFICE USE ONLY: <br /> (RONTSFTp�CN REAIiSF.TPRCK S�DESEIBPCIt PI�NCn[f.NNUWPFn �[[ /� RECF.IPiNO. <br /> ��� <br /> use zoNe i.ot�nen vncnNt srte FEES VALUATION FEE <br /> nvcs i', No nun.nivr, <br /> 0 oao 3 ; OD <br /> NEIGNTUMIT�TION NOOFUWElLINO SIZEOFNLDGT <br /> UNIiS �� i <br /> PtUMpING <br /> OCCUP�NCY NO Oi SfOPlCS OCCUP�M/O�D 8 SEMENI � <br /> GROUP / � M[CH4NICAl. — _ _ <br /> /j II\C$ �I NO � <br /> FlRE^�U/RM pEOD Pf450N AODIIIONAI.PUN GHf f,K � <br /> /V�� ' <br /> OiHER � <br /> FIRF.SPRINRIERnFOD nFnctM� <br /> �L'� /' SiAI[OIIII�IYG SURCHAII(E � <br /> ��__ <br /> TYPEOfCON51 rinHs ovenor GTYOFEVERETT rum�cworKs , <br /> III ^ I ��� ��CAL SALES -- �—�� <br /> ��A�� �2 .,a�- TAX CODE IS 3105 TOTAL <br />