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APPLICATI�,N FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DI\'ISIUN � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />r7 DEMOLITION �l COMBINA710N f 1 BUILDING 'Q MECHANICAL f � PLUMBING f� SIGN <br />�PROJECIADDRESS <br />ownE� <br />cm zir <br />arv <br />MCMITFCTOPpE51GNER MAILRDpRf:55 Glty ZIP PHONE <br />GENERnICONTRnCIIXi MAILADDRESS <br />n110NE STATELIC[NSEr <br />MECNANICALCONiR�CTOR MAILAD�RE55 CITY ZIP PIIONE STRTEUCENSE• <br />_ __... _._.. ._..._...,.,,...,., wi <br />CONTRRCT PRILE OF WORN <br />�?870. o p <br />DESCRIBE WORK ANO SOURRE FOOTAGE INVOLVED <br />..�r%JS //F�er (�OA�✓E�S/nN <br />PROPOSEO USE OF BUILDING <br />LEGQ DESCFIPTION OF PROPEHiV (SHONTJ BELOW OR ATTPCN TVJD COPIE51 <br />�UT BLOCK OF <br />P4RCELTR%ID.NUMBER <br />CONSTRUCTONLO�NLENDER.R��PESS.TELEPNONE NUMOER <br />PLUMBIN6 <br />NO. <br />SINK 8 DISP <br />TqA1' <br />WASHER <br />DRINKING FOUNL <br />FLOOR DRAIN <br />BACKFLOW PREVI <br />SINK (SERVICE — <br />FOR OFFICE USE ONLY: <br />FRONT SETFfACN PE�R SETp�CN <br />USE ZONE <br />HEIGMi LIMIipTION <br />LO'iAREA <br />ZIP p110NE STATE IICEHSE � <br />HEATING SYSTEM: �'GAS fl ELECTRIC Cl <br />CONT4CiPER50NANDP110N[NO � <br />- "/'/yR—X..7/� <br />I HeREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF lAWS AND ORDINANCES 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 />AUTHOFITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCF OF CONSTRUCTION. THAT I AM AUTHORIZED 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!/� L-/Y-Sr <br />SIGNAtURE DATE <br />Oa 9�s-i <br />CItY tlUSINE55lICEN�[ NO <br />OR ITEM FEE NO. TVPE OF FI%TURE OR ITEM fEE <br />� A/C —A/FiNDLG UNITS — H,P. <br />; FORCED AIR SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />' UNITHEATERS—B.T.U. M <br />i CLOTHES DRYERS <br />� VENTILATION FAN <br />i RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />� METAL FIREPLACE (WODD BURNING) <br />_ � FIREPLACE INSERT (WOOD BURNING) <br />; GAS FIREPLACE <br />%�) GAS RANGE <br />GAS PIFING <br />i E%HAUSTFAN <br />SUBTOTAL 5 <br />PERMIT $ <br />TOTAL FEE S <br />N0. OF DWLLLING <br />UNIiS <br />SIDE SETpACN <br />V�CANi SITF <br />IlYES fl NO <br />512E OF OL�GrtI <br />IlY[S fl NO <br />OUILDING <br />P W MOMG <br />MECNANICAL <br />ADDIPONAL PLAN CHECK <br />OiMEIi <br />IINNL[RRE00 t1F�50N _ <br />SIAI[ Bl11LDMG SMC �MGE <br />cor+sT ntnNsnrrnoveoov CiTYOFEVERETT rueucwones <br />LOCAL SALES <br />oAiE TAX CODE IS 3105 70TAL <br />SUB70TAL S <br />P:RMIT $ <br />TOTALFEE $ <br />fF.E IqECHPTNO. <br />