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APPLICATIOim FOR CONSTRUCTIuM PERMIT <br /> CITY OF EVERETT • BUILDING DIVISION <br /> 3200 CEDAR STREET A EVERETT. WA 98201 A 259.8810 <br /> ❑ DEMOLITION 1-1 COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: - 7•� - �, T� ��( �� <br /> Comm 1� MAIL ADf111EI.S CITY ZIP PHONE <br /> J /11A <br /> /�F Fo.0 /'%Z//r-1 S l'AV ;� /)lf//( ��wC F6c'I z -/L -.,T 3Gi <br /> I ENANI f MAIL ADOCICSS CITY IIP PHONE <br /> AfIC1UTCCI OR DESIGNED MAII ATKTBESS Clry IIP PHONE <br /> /11q d/3a AIC' _r 4's 1y h.Qi /I�'[I(iLIFft11 s 1 Q <br /> CENFnAI COIORACICII MAIL ADIMESS CITY ilr PHONE "AT[111 0 <br /> MECHANICAL CONIIMCTOn MAIL ADDRESS F.I TY lip PIIONE STATE IICENSE I <br /> PLUMBING CONIRACIOR TAIL ADDRESS CITY ZIP PHONE STAIL UtENSEA <br /> CONTRACT PnICE Of'iVORK <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> DESCRIBE WORK AND SOI LRE rOOTAGE INVOLVED CONTAC I PITISCH AND PITON[NO <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> - APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROPOSEOUSE of 9UIl01NG PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> IEOA'.(fWAIr.f•'Or PROPERTY(SHOWN BELOW CR AtIACIFTwOcorIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LO1_�c� "BLOCK D- �P-L f nc AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> _ PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM TITE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TM IB NUMBER CONTRACTORS LAW 18 27 RCW AND 296.200 WAC}. <br /> CONSInUC11O14 LOAN LENDER.A[MNIESS.TET EMIONE NUMBER X I^ " "?., <br /> SIGNATURE DA E <br /> CITY BUSINESS I ICCNSC NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE _NO. TYPE OF EQUIPMENT FEE _ <br /> .S WATER CL03L I (TOILET) I A/C—ARINDLG UNITS <br /> Z BATHTUD _ ; FORCED AIR SYSTEMS <br /> LAVATORY 11111,SH BASIN) I HEAT PUMP i— <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 6 DISP L _CLOTHES DRYERS i <br /> DISHWASHER RANGE IIOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> _ URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT(WOOD BURNING) <br /> FLOOR DRAIN / GAS FIREPLACE _— <br /> BACKFLO'N PREVENTERS ) GAS RANGE <br /> SINK(SERVICE—BAR,ETC.) �— GAS PIPING �— <br /> L/ EXI IAUST FAN F <br /> I <br /> I � <br /> I ! <br /> I/ SUB TOTAL S ") SUB TOTAL S ../ <br /> _ PERMIT $ `) i PERMIT S <br /> TOTALFEE S I TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FRON� I REAR SETBACK SIDE SE IBACK �� PL AN CIIECK NIMDFA Mr RFCFIPI NO - <br /> USE ZONE LOT AREA VACANT SITE J FEE/S VALUATIONFEE <br /> OYES 0NO BIIIIDING 775,1 r, Iz-1—A <br /> IIEIGIIT IIMITA401 NO OF HWEILING SNE Of BLUDR1 <br /> / )CY UNRS 1p3 , y IV 4JeR+ HUMMING <br /> OCCUPANCY NO OI OMES OCCUPANT LOAD BASEMENT <br /> GROUP MFCHANICAI I <br /> 9 3/J I { OYES m4G/ <br /> EIRE SPRINKLER REG.) RFASON ADMIION AI PI AN CNff"K <br /> Dunn I <br /> FIRE AlAfIM TIED'D NFASMI <br /> STAF RIIILOING SIInCOHARGE <br /> j. <br /> I YrE or CONST PI ARS APP OP <br /> BY CITY OF EVERETT ronoc won.S / <br /> r LOCAL SALES <br /> A_ <br /> '/Y/ DATE IJ CG, TAX CODE IS 3105 TOTAL 1 <br />