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.- <br />APPLICATIOrI FOR CONSTF�UCT�ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />fl DEMOLITION fl COMBINATION fl BUILDING fl MECHANICAL t� PLUMBING fl SIGN <br />PROJECT ADDRESS <br />SZ' <br />S� <br />cin <br />Z <br />PHONE <br />Z� <br />��ryAn� MAILApDRE55 CITY plP PHONE <br />ARLHITECTORDESIGNER MRII.�O�FIi55 f.m 71P PMONE — <br />GENERnLCONiRACTOR MAILa0�RL5S CIIV I�p PIIONE $iAiEUCENSE� <br />MECHANILALCONTRACTOR MAILADOPR55 dTV 21P PHONE STATELI�ENSE� <br />���l���it�e 3o i5' Z ��-'' sr ��,,�rrcr, 9Pzo� z- S 9 sos� <br />PLUMBINGCONTRpGTOR MAILA�DRE55 CI�Y ZIP PNONE SiAIELICL'NS[� <br />� l. Vfi I H11C I YN/IC�E OF <br />�JJJe <br />iOESCRIBE WORK ANO <br />�t ,P A.. � : <br />G1 <br />LOT BLOCK <br />YRHGEL L1X I.p. NUMBEF <br />CONSTFUCTIONIOANLENOER.A00RCS5.TElEPNONENUMBER <br />PLUMBING <br />NO. TVPE OF FlI(TURE OR fTEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WpSH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK lSERVI(:F — Rnw Frr i <br />FOR OFFICE USE ONLY: <br />P{iONT SFTPACN REAfI SFTBACK <br />USE ZONE <br />HEIG/R UMITATION <br />OCGUPANCY NO C <br />f.ROUP <br />FIRE RUPM REO�D <br />FIRf SPRINKI Efl RF. <br />TVPF Of f,ONST <br />SUB TOTAL 3 <br />PERMIT 5 <br />TOTAL FEE $ <br />SIDE SETBACK <br />HEATING SYSTEM: f l GAS fl ELECTRIC fl <br />CONTACT PERSON AND PHONE N0. <br />I HEREBY CERTIFY THAT � HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORflEC7 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 PqESUME TO GIVE <br />AUTHURITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br />PEF;FORMANCE OF CONSTF�CTION. THAT I AM AUTHORIZED BY TH� <br />OWNER OF THIS PHOPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />�C_=��f'���""'�� zzs ���c7 ' �Z- �! S— <br />SIGNRTU pqTE <br />CITY BUSINESS LICENSE N0. <br />MECHANICAL <br />NO. TYPE OF EGUIPMENT FEE <br />A/C — A/HNDLG UNRS — H.P. <br />FORCEDAIRSYSTEMS—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 />� <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE IWOOD BURNINGf : <br />GAS FIREPLACE <br />GAS RANGE <br />EXHAUSTFAN <br />SUB TOTAI 3 <br />PERMIT 5 <br />TO?AL FEE S <br />PL�N CIIECK NUMAf:R � PFF � RECF.IPT NO <br />I.UiAqEA VACANf$RF. FEES <br />f I VFS f i ND <br />DUIIOWG <br />NO OF OWELLING SIZE OF HIIXi/I I — <br />UNIIG <br />PLUMFlING <br />OCCUPANTL040 BASEMENi MECHnNICnt <br />115E$ ii NO <br />{iFASO4 — hODIIIONM.PIANCH[CK <br />on�en <br />FF�SON <br />St�1G OIOIOMG 91RC11�RGE <br />PI�NSAPPROVEOBv CITYOFEVERETT ruoi.ir,wonKs <br />LOCALSALES <br />unrE TAX CODE IS 3105 TO7AL <br />. <br />