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. -- .�. � <br />APPLICATION FOR CONST�tUC�IQ�N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •�G9-8810 E` <br />❑ DEMOUTION COMBINATION fl BUILDING f7 MECHANICAL fl PLUMBING ;�l $IGN <br />PROJECTADDNESS I2a$ �CJJ� c_l-��. ��� I ��� <br />J .7J <br />1e57n I�YAMel(, 1.C. IiC`il�', 15��1Ylcll-?a/cv'ett 1�ui lSlri>"leu ��J�t�t ',�10- t,o��.-i Uv -io�-�u�ia� <br />1ENANT MAILAODRESS QTY. I ZIP PHONE <br />\1 <br />APCNITECTORDES�GNER N�ILAOORE55 CITY ZIP PHONE . _. <br />GENERAL CONTP�CTOR MAIUDORESS CITY ZIP PNONE STATE LICENSE � ' <br />�Gl/YY1� , , , { � , . .: , <br />MECH�NICALCONTRACTOR MAI�pD�RE55 CITY ZIP PHONE STATELICENSE� <br />1 ,. . i n .. -1 � n � -. . . I . cL.. . , n �, -i.- e 7 ^.. , . .. . , � � . . , . •. � ; i � <br />l0T <br />MAII <br />OF YNRK <br />raovean �s <br />BLOCK _ <br />)� LA �� �- � �.h-�- � <br />LENDEN.ADORESS,TELEPHONE <br />OF flXTURE OR ITEM <br />BATHTUB <br />LAVATORV (WAfH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWASHER - <br />LAUNDRYTRRY <br />CLOTHES WASNER <br />URINAL <br />DRINKINO fOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />HEATING SYSTENi: <br />' ��� <br />GAS f-1 ELECTRiC fl <br />I HEREBY CERTIFY TNAT t HAVE REAb AND'EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CPRRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />' NOL THE ORANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOR!TY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW RE6ULATIN4 CONSTRUCTION OR THE <br />PERFORMANCF.. OF CONSTRUCTIQN. iHAT I AM AUTHOflIZED BY THt <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FbR WHICH <br />APPLICA7iON IS MADE AND I COMPLY WITH THE Sl'ATE <br />CONTRAC'ORS LAW 18.27 RCW AND 296200 WAC. <br />x IL�'X�1 I����� <br />SION�TURE � O�TE <br />CITV BUSINE55 LICENSE NO. <br />MECHANICAI <br />FEE NO. 7YPEOF�EOUIPMENT FEE <br />� A/C—A/HNDL4UNITS—H.P. <br />' FORCED AIR SYSTEMS — B.LU. M E.A. <br />--� ' ' � HEA7 pUMP <br />� �. � UNIT HEATERS — B.T.U. M <br />; CLOTHES DRVERS <br />—r <br />� <br />� .I'��'-!�'� �. ��'�� RANdEHOOD <br />i WATER HEATER <br />� WOOD STOVE <br />� � , �' �� � METAL FIREPLACE I <br />� FIREf'LACE INSERT <br />� OAS FIREPLACE <br />� OAS RANGE <br />� ' GAS PIPINO <br />, EXHAUSTFAN <br />6UB TOTAL $ <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ON�t': <br />FRONTSETBACN / 9EM"':TBIICN � <br />� � <br />USEZON�✓� �LOURE� <br />HEI6HT <br />FIRE <br />NO.OF DWELLIM3 <br />� UNIfS <br />DAtE <br />SIDE SETBACK �/ PUN CHECK N 1/fiEP <br />5 <br />VAC�Ni SItE FEES <br />f1YE5 fl NO BUILDING <br />)F BL I <br />� � �-) R ` .} PLUMBING <br />BASEM9NT � MECH/NICAL <br />fIYES ItYNO <br />ADDITIONRL PUN C��ECK <br />OTHER <br />' STATE BUILUING SURCHAqGE <br />CITY OF EVERETT �IIBLIf, WORNS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />� <br />i <br />i <br />SUB TOTAL� E ; <br />rF.RM1T S � . <br />TOTALFEE S ' <br />fEE� RECEIPTNO. . <br />