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APPLICATIt��I FOR CONSTR�3CT�ON pERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 9gpp� . 259•8810 <br />fl DEMOUTION fl COMBINATION (�l BUILDING �MECHANICAL r l PWMBING f l SIGN <br />PROJFCT ennoec� <br />""' ���' PHONE � <br />GENERPLCONTMGTOR MAILAOORESS <br />CITY IIP PMONG SiATE LICENSE r <br />F�/'e G�i .o�'% p,o �/3 30rJ 3oY� Sv'- �'1% � e g�0o5 6y'/-1/1 > �-'r P!'% 'i9 h <br />MECHANICALCONTRAC70R MAILADOPESS � �� <br />CITV ZIC PHOYE SiATE LICENSE � <br />PWMBINGCONiRAGTOR MRILADORE55 ��n. <br />ZIP PHONE $TAiE I.ICENSE � <br />,�"3� vg. oa- <br />�DE CRIBE WORK AND SOU4RE FOpTpGE INVOLVED <br />�su/ G�/D2 7 Sssdn <br />e <br />� � srr�//e �l � .�'rc/ ,0 6 a/ <br />� �8:*3 � KOsy �i�H2 � <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPT�pry OF PR(IpERTV �SHOWN BELOW IXi ATfpCH <br />LOT� BLIX:K OF <br />VAR(,EL TA% I.D. NUMBER <br />CONSTRUCTIONLOAN LENDER.ADDRESS.TELECHONE NIIMBER <br />PLUMBING <br />�� NO. TYPE OF Fl7(TUflE OR I7EM <br />i — <br />; WATER CLOSET (TOILET) <br />! BATHTUB <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRqY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PqEVENTE <br />SINK (SERVICE — anw <br />FOR OFFICE USE ONLY: <br />FRONTSETPACN REAR SFTBRCK <br />USE ZOIJE <br />NEIGHT LIMITATION <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />HEATING SYSTEM: f l GAS !-1 ELECTRIC �I <br />COyTRCT PERSON r1N� PMONE N0. .0 G/_ Oi o� r <br />0'� �0.�, �e�.� 'c.f� � y/—.2/2 � <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED 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 />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED 8V THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK fOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LA�27 RCW AND 296200 WqC. <br />� <br />x' /-D9-9� <br />51 i / �ATE <br />�� <br />CITY BUSINE55 LICENSE NO. <br />NO. I TYpEOFEpUIPMENT FEE <br />HNULG UNITS — H.P. <br />AIR SYSTEMS — B.T.U. M E.A. <br />HEAT <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />i7ANGE HOOD <br />WA7ER HEATER <br />WOODSTOVE <br />METAL FIREPLACE <br />FIREPLACE INSER <br />GAS FIFEPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />SIDESETBRCK IP�pNCHECKNUM9[R FEf- RF.CEIPiNO. <br />ItOTnREA ypCANi517E � FEES <br />IIVES ft NO <br />-- BUIL�ING <br />NO.OFDWELLING SREOF0I.DGR1 <br />llNlfS <br />PWMI3ING <br />OCCUPANTLOAD BASEMENi <br />MECIIANICAL <br />IWES I�NO <br />qFASON APDI IION41. PI AN CHl:CN <br />FF�SON OTHER <br />SiAiE 9UIl�IN , SURf,11MGE <br />�'L�NSA PppyED9V <br />�M CITY OF EVERETT runi ir, wonKs <br />/ LOCALSALES <br />uarE (/(/ �j�j TAX CODE IS 3105 TOTAL <br />