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APPLICQ.TIV�I FOR CONSTRUC7 sON PERMIT <br />CITY OF EVERETT • DUILDiNG DIVISION <br />3200 CEDtiFl STREET • EVERETT, WA 98201 • 259-8810 <br />fl DEMOUTION L�COMBINATION G�BUILDING f"� MECHANICAL r,✓pLUMBING f 1 SIGN <br />PROJECT ADURESS f� <br />� <br />�! f �, <br />IENA�Jf <br />//�' a� / � �� Gc� <br />. MAILAODf1E55 CIfV . 21P PIIONF. <br />��'7/7- 3b'C`"� ��� 9/.� <br />MAIL ADORf.55 �ITY <br />AqCHITiCTOR0E51GNER MAiI AOOf1E55 <br />�rJG� (S.�-/�ny' <br />71P PIIONF <br />GENEf1FLCONTRRGT MJLAOORE55 CIIY ZIP P�IONf. $IATEI.ICGNSE� <br />/ ) � / Ij� <br />�'L�-l'11% ��... ��, e.,-,�� ,,t ��-�� G� «.G<r..� f�al� H S� ��;, <br />MECH4M �CO:JiR4CTOR AILADORE55 CIiY 71P PIIONF �STATELICENGE� <br />PLLIMBINGCONiRAGTOR IdA1LAf10PE55 CITY 21P PHONE STAiELICF.NSE� <br />CONiRACiPAICF OF WOnH <br />DESCRIBE WOFK ANO SOUARE <br />LEGAL DESCRIPTION OF PROFERTV <br />LOT � BIOCN _ <br />PARCEL'AXID.NUMBER <br />INVOLVE� <br />_ or. <br />CONSiRUCTION LOAN IENpEP. ADDPESS. TELEPIIONE NUM(FR <br />PLUMBING <br />NO. TYPE OF FI%TURE OR <br />Z WATER CLOSET (TOILET) <br />Z BATHTUB <br />� LAVATORY (WASH BASIN) <br />SHOWER <br />I KITCHEN SINK 8 DISP <br />IAUNDRYTRAY <br />CLOTHESINASHEH <br />URINAL <br />DRINKING FGUNTAIN <br />FIOOR DRAIN <br />BACKFLOW PREVENTERS <br />SIPJK (SERVICE — @AR. ET <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE 5 <br />FOR OFFICE USE ONLY: <br />FRONT SF.TPACN RE4R SFT04CN SIDE SET9ACK <br />USE ZONF � <br />HEIGIIT LIMIT tl( <br />OCCJPANCY NI <br />F�GR UP <br />ALAfJM REC <br />�/ � <br />fIRF. $t'F^uKI.f.R <br />/Yn <br />LOiAREA <br />NO OF DWELLING <br />UNIfS <br />OCGUPANiIOFD <br />i1fA50 �� <br />RGAcpN <br />onre /U//D '� <br />FE� <br />0 <br />FIEATING SYSTEM: I%TvAS �l ELECTRIC (� <br />CONtPCT1'FP50�/{ ND fON NO <br />�i��_.1�� ��I.._.�✓ ������JG <br />� HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE A4D CORRECT ALL <br />PROVISIONS OF lAWS AND O!�DINANCES GOJEri1JiNG THIS TYPE OF- <br />WOHK WIIL BE COMPLIED WITH WHE'0+`R 3PECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT GOES NOT PRESUME TO GWE <br />AUTHORI?Y TO VIOLATE OR CAN�EL TH[ PROVISION OF AN'! <br />OTHFH STATF OR LOCAL LAW REGULAi ING CONSTRUCTION OR THE <br />PERFORMANCe OF CONSI RUCTION, THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PRUPERTY TO PERFORM THE WORK FOR WHICH <br />Af'PLICATION IS MA�E AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1 27 RCW AND'L96.200 WAC. <br />X �i.�� ,��Guc�/�- /0 —.2 —i S' <br />S�GNATURF / DntE <br />QTY �USINE55 LICENSC NO <br />MECHANICAL <br />NO. TYPE OF E�UIPMENT FEE <br />T <br />A/C — A/HNDLG UNITS — H.P. <br />�— FORCF.DAIRSYSTEMS—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 />WATER HEATER � <br />WOOD STOVE ' <br />METAL FIREPLACE (WO'JD BURNING) i <br />— _,— <br />FIREPLACE INSEPT (WOOD BURNINGI � <br />GAS FIREPLACE ' <br />T <br />GAS RANGE � <br />GAS PIPING ; <br />/►.. EXHAUST FAN � <br />SUF�TOTAL S <br />PEFMIT 5 <br />TOTAL FEE S <br />PlANC11ECNNUM1�AFfj I FE[ � �fCFIPTNO <br />vncnrvr SirF FEES <br />IiYES il NO <br />omtnwr <br />srzE o� eiocm �0� �! <br />Q PLUMORJG <br />9l5EMENi `/ 6 MF.CN�NIf.AL <br />IIVES 1 0 — <br />ApDI11pNA1. PIAN C��f.CN <br />OTHGR <br />SiNE �UIIDIN' SI:�CNMIOE <br />CITYOFEVERETT rimiic,vonKc <br />LOCALSALES � <br />TAX CQDE IS 3105 TOTAL <br />FEE <br />i <br />�� � <br />i — <br />���C� <br />