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APPLICATI6rd FOR CONSTRUCT ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />fl DE�AOLITION fl COMBIVATION ,1 BUILDING rl MECHANICAL f� pLUMBING (l SIGN <br />PROJECT ADDRESS <br />lu �,� s�1 /5 <br />iEN�NT MAtUDpRF.55 --� - � .'IU/. _l.i ��jLJ� <br />� � CITV ZiP 1 {`NONE <br />i <br />�RCNITCGiORDE5IGNER Ms11.�DU9E55 CItY )� � PHONF. <br />/� <br />GENER�LCONTRRCTOR MAILp0ORE55 CIIY .�P PNON[ $L4IEIICFNSE� <br />MECHFNICAI CONiReCTpq MML qDDRE55 QTY Zlt� p110NE $TATE LICENSE � <br />PLUMBINGCONiR�f.TOR MAILAODRES$ CIiV zIP PNONE STATEUCENSE� <br />�.VI�INl1{�1 {`MCE Of {�(� <br />�I� ��O <br />OESCRIBE WOqR �ND SOUARE FOOT�GE INVOLVEU <br />1EG11L DESGRIP}IpN OF PROPERTY (51101M� BEIOW OR RTT�CH <br />LOT BLOCK pF <br />PARCEIT�%IA.NVAIBER <br />4�SB Oo6 Dil oc <br />CONSTRUCTIONLO�NLENDER,�pppE55.TElEPNONE NUMBER <br />TYPE OF FlIRURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORV(WASH BASIN) <br />SHOWEH <br />KITCHEN SINK 6 �ISP <br />DISHWASHER <br />UUNDHY TRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SUBTOTAL <br />FOR OFFICE USE ONLY: <br />fRONiSF.TP�LN qEAR SFTBRCN <br />USEZONf: <br />HEIGNi LIMIT�TIDN <br />or r,orusr <br />LOi�RER <br />NO Of pWELLING <br />UNIIS <br />�i <br />� <br />SIDE SETB�CN <br />HEATING SYSTEM: I l GAS (-1 ELECTRIC <br />CONTPCT PF.RSON qNU PIIONF NO. <br /><l/ If�loN 35�3-3!l! <br />I HEREBY CERTIFV THAT I HAVE READ AND ExANINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORD�NANCES GOVERNING THIS TVPE 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 CUNSTRUCTION. THAT I AM AUTHORIZED BV 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 R AND 296.200 WAC. <br />X ���, G��/9s. <br />SIGNnTURE ' DRTE <br />CITV BUSINESS LICENSE NO <br />FEE NO. TYPE OF EQUIPMENT FEE <br />A/C — A/HNDLO UNITS — H.P. <br />; FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />HEAT PUMP <br />; UNIT HEATERS — B.T.U. M <br />VACRNI SItE <br />nves r rvo <br />SIZE Of BtD(:RI <br />9�� s�. <br />IIVES I(/PO <br />RANGE HOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL fIREPLACE (WOOG BURNINGI <br />FIREPL�CE INSERT (WOOD BURNING) <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />cXHAUSTFAN <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />1'l�NC11Ef.NNUMf3fR fEF <br />FEES VAL <br />OWLOING f � <br />.J <br />riuMnvuc <br />M[OIRNIf,RI <br />/.Dpi110NM.PIANCNff,N _�� <br />on�[n <br />RF�S(N� <br />S1A1[ 91111DWG <br />v�nHsnrrnovennr CI7VOFEVERETT runi�r,wonKs <br />J � LOCAI SALES <br />onre r/� .`- �/i 1 TAX CODE IS 3105 70TAL <br />RF.CFIPT NO <br />