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APPLICATIO.� FOR CONSTRUCT�JPI PERMI'� <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVFRETT, WA 98201 • 259-8810 <br />rl DEMOUTION fj]�COMBINATION I?�UILDING I�'MECHANICAL �t' PLlJMBING f 1 SIGN <br />PROJECT AD�RESS //�3� / � � n� `� <br />��. <br />OWNER MnILAODRESS �` CITV ZIP {'HON@ <br />1�.' �,.�� [� 3� 7 � �J - 3 G n�.,� � Cc • �. ��-u.�-..-.--e � �,1, �� �a 9� G s ,�z - % � o � <br />ARCHITf.CT OR OESIGNE(1 MAR AO�RE55 Gltt IIP PHOh[ <br />PLUMBINGCONTRAf.TOP MAILAOOREfiS CI7Y zIP PHONE SiFTELICENSE� <br />CONTPFCT PRICE O� WOfiH <br />DESCPIBE WORK AND SOUARE FOOTnGE INVOLVED <br />��.w- � �4�=-� <br />PROPOSEO US/f/ OF 0111LDING /, <br />�'s�y � f[iJ1. / <br />LEGRLDESCRIPTIOh FPROPERTY�SHOWNOEL W <br />LOT � BLOCK OF_ <br />/% _ !� . . ' � -_ <br />AifAGH T WO COR E5) <br />/ a aki , i. �� <br />. � <br />PPqCEITn%t.D.NUMBER <br />CONSTRU�TIONLOANLENDER.AD[1RESS.7ELEPHONE NUM1IOER <br />PLUMBING <br />NO. TYPE OF FIXTURE <br />WATER CLOSET (TOILET) <br />BATFITUB <br />LAVP:i ORY (WASH FASIN) <br />SHOWER <br />� KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTH[S WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK ISERVICE — BAR. El <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FPONTSFTPACH REAB SFTO�CN <br />USEZONE � _3 LOiAREA <br />✓ <br />HEIG11i LIMI�I� / NO' OF pWELLING <br />FIREALARMFE00 RF�50Y <br />�I � <br />FIRF. SPryNNIER RF.OD RFASON <br />N� <br />TYPF.OFf,pNST P14NSAPPRpVEDOY <br />� �� s�� <br />�>�,E �a�v <br />FEE <br />SIDE SEiBACN <br />VACPNISRE <br />tiYES f� NO <br />HEATING SYSTEM: Yi}�GAS �l ELECTRIC fl_ <br />CONjqCi �' ^RSOJI AtlD ApN[� NO. . .� � �_ � _ / � O <br />I C_� C l' <br />I HEFFBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION I1ND 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 OR <br />NOT. TfIE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF l•.'JY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIO� OR THE <br />PEFiFORMANCE OF CONSTRUCTION. THAT I 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 296200 WAC. <br />x � Gc..1(�.� '� 1Y�C=, „u�� /o - � -/' S <br />SIGNFTURE / DATE <br />CRY BUSINE55 LICENSC N0. <br />NO. TYPE OF EOUIPMENT FEE <br />A/C — A/HNDLG UNITS — H.P. � <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 />WATER HEATEii --' <br />WOOD STOVE <br />METAL FIREPLACE (VJOOD BURNING) i <br />FIqEPLACE INSERT (WOOD BURNING) � <br />GAS FIREPIACE ' <br />� <br />GAS RANGE � <br />GAS PIPING ; <br />� EKHAUSTFAN i <br />SUB TOTAL 5 <br />PEFMIT $ <br />TOTAL FEE 5 <br />^:annen � ree _ _ � r+ecFmrr�o. <br />fiUItDMG <br />$IZEGF IDQ�fI /J '; , <br />/O .y s �GC`l Zi�" PLUN�WG <br />c <br />6�SEMENT MECII�tJICAI <br />I1VE5 11 NO <br />Appi IIONAI PI RN G��I.CK <br />�,��F� <br />STf•� � pW l OMG SURC11! RCE <br />CITY OF EVERETT rumicwonKs <br />LOCAL SALES -- <br />TAX COUE IS 3105 70Tp� <br />� <br />DU <br />