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APPLICATIOrV FOR CONSTRUC7 �ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEGAR STREET • EVERETT, WA 98201 • 259-8810 <br />DEMOLITION fl COMBINATION I-1 BUILDING fl MECHANICAL f l PLUMBING fl SIGN <br />IOJECT ADDRESS 2 � <br />iENRN� <br />N`� CO I PHON�^ � VI ' <br />Y/ <br />ZIP PI{ONE <br />ARCHRECTOROEGIGNEF MnIlA00RE55 CITV 71P I+HONE <br />GENEf7ALCONTR�GTOfi M41lAD�BESS CIiV Z�P PIION[ StATEIICGNSEe <br />�or <br />MAIL AD�RF55 <br />MAIL ADDRESS <br />SOUARE FOOTAGE INVOLVED � <br />OF PROPF <br />_ eiocK <br />CITV <br />CIN <br />PARCEIT t.D.NUMBER <br />�375 �3� 0/7 n�`, <br />CONSTRUCTION IOAN LENOER. AODRE55. iELEPHONE NUMBER <br />• v�uMeiNc <br />NO. TYPE OF flXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ETC.1 <br />COPIE51 <br />)iJ <br />FEE <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />fRONTSFTPACK RE�R SETBALK <br />I15E20NE IOTAPEA <br />HEIGNTUMITATION NOOFUWELLING <br />❑NIIS <br />OGGUPANCY NO Of $tORiES OCCUPANi LOAO <br />GROIIP <br />OAIE <br />SIDE SETBACN <br />ZIP PIIONE STATE LIGENSE • <br />PIIONE STATE LICENSE • <br />HEATING SYSTEM: f 1 GAS I-I ELECTRIC f � <br />CONTACT PERSON AND PHONE NO <br />I HEREBY CERTIFY THAT I HAVE READ ANO 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 -'IlL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOI. � GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTh Y TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER a iATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 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// � l/'�7-�S <br />SIGNATURE O�TE <br />CITY BUSINESS UCENSE N0. <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />A/C — A/HNDLG UNITS — H.P. � <br />� <br />FORCED AIR SYSTEMS — B.T.U. M E.A. � <br />HEAT PUMP � <br />UNIT HEATERS — B.T.U. M � <br />CLOTHES DRYERS ; <br />VENTILATION FAN � <br />RANGEHOOD ' <br />WATcA HEATER �— <br />WOODSTOVE � <br />METAL FIREPLACE (WO(1D BURNING) i <br />FIREPLACE INSERT (WOOD BURNING) � <br />GAS FIREPLACE ; <br />GAS RANGE � <br />GAS PIPING ' <br />EXHAUST FAN ; <br />VaCI ANI SIIF. FEES <br />IIYES ��M1O OUILOING <br />SIZE O� EL03'[I <br />PLIIM�ING <br />PASEMENi MFGI�NICAI <br />IIYES Ii NO <br />—` AD�I I IpN�L PLAM CNf.CN <br />OtiIER <br />SiNF OIIIlO!NG SIIf1C11Af10@ <br />CITY OF EVERETT ��um ic wonKs <br />LOCALSALES <br />TAX CODE IS 3105 7o7AL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />PEF � RFCFIPTNO. <br />