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APPLICATI( .V FOR COIdSTaUC1 .ON PIEF�NIi'r <br />CITY OF EVERETf • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 0201 • 259•0810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �ECHANICAL [] PLUMBING ❑ SIGN <br />PROJECTADDRESS: . iIZI �� PL S� ���fO� <br />% Pi�'( �jUl.�� Jka � <br />OYMER MAIL�OURE55 Lltt ZIP PIIONE <br />M�ILA��RESS CITY 7��' PI�ONE <br />AqCNITECTOR0E51GN[B MAllId1�RE55 CITY IIP <br />GENEML LONTRALTOfi M�ILA��R655 QIY 71P ^IIONE SUIE IICENSE � <br />� Sp�utE G�5 �LwtcP� gOX �Z.il3 /�ic� fILCE+� �/� J`�gZ Ag5DLG50SSRw <br />� MECNANICRL CONTRACTOR MAIL ADDPE55 CIN LP PIIONE $T�TE UCENSE � <br />PLIlA1BINGCONiPFCiOR MAILADORESS CITY ZIP PHONE $TATEIICENSE� <br />CONTRACT PRICE OF WOqK � � � <br />i <br />UESCRIBE NURK ANO SOU�RE FOOTAGE INVOLVED <br />1� � ��( (� � c 1'iq, <br />LEGAL �ESCflIPiION OF PFlOPF <br />LOT 9LOCN <br />PMCELTA%I.D. NUMBER <br />OR ATT�CN TWO COPIES) <br />CONSTflUCT10N IONI LEN�ER. ADURE55. TEIEPMONE NUMBER <br />NO. TVPE OF FIXTUR[ OR ITEM <br />WATER CLOSET (TOILET) <br />LAVATORY <br />KITCHEN SINK 8 OISP <br />DISHWASHER <br />LAUNDRY TRAY <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DflAIN <br />DACKFLOW PREVENTE <br />SINK (SERVICE — BAR, <br />FEE <br />SUB TOTAL S ; <br />PERMIT $ � <br />TOTAL FEE S � ; <br />FOR OFFICE USE ONLY: <br />FRONTSETAACN REAR Sf.TBALK SI�ESEiOACN <br />USEZONE LOi�REA WC�Nf51fE <br />❑YES ❑ NO <br />HEIGMT LIMITATION NO OF UWEI!B:G 512E OF OIOGRI <br />UNIiS <br />nf SION[5 <br />❑YES ❑ NO <br />ivveorr.oe�sT IrinNsnrrnovEnov CITYOFEVERETT <br />LOCAL SALES <br />,,.,� TAX CODE IS 3105 <br />HEATING SYSTEM: �GA5 ❑ ELECTRIC ❑ <br />LONIACi PE�SON AND PHONE NO <br />I HEREBY CERTIPY 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 Oa <br />NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br />AUTHOFii"1' TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OFi THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORRED BY THE <br />OWNER OF THIS PROPEflTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.2Q0 WAC. <br />J( �4/ � ��"r+��%� <br />Z. <br />SIGNATUO� D6TE <br />LITY BUSINE55 LICENSC NO <br />MECNANICAL <br />NO. TYPE <br />N V� Nf 11\YL\] V I�I IJ <br />FORCED AIR SYSTEMS <br />I1EAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />WATEFI HEATER . <br />MEfAL FIflEPLACE <br />GAS FIREPLACE <br />GAS PIPING <br />EXHAUSTFAN <br />PlAl1 <br />OUII DING <br />PIUTApWG <br />1AECIIANICAI <br />ADOIIIONAI. PIRN C�I[LN <br />OIUEfl <br />STAIC 6lIIlOR�C SiInLllnpCE <br />runi ir. wa�Ks <br />TOTAL <br />FEf <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE S <br />nEc¢mtNo <br />FEE <br />