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APPLICATI�7R FOR CONSTRUC7'�N PERMIT/ <br />CITY OF EVERETT • BUILDING DIVISION GC���� <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 � �T <br />f7 DEMOUTION fl COMBINATION rl BUILDING f7 MECHANICAL �! i'LUMB!NG fl SIGN <br />PROJECT ADDRESS <br />r <br />zm rNor� <br />-03 </> <br />21P PNONE <br />ARCNITECTOROESIGNER MAII�DORE55 CI1V ZIP PMONE <br />GE RALCONTP�CTOq MRILRD�RE55 p C�TV ZIP PNONE ST�TELICENSE� <br />�.J J_oa.� rlvi>.O.c.�,� Fr /II�/��/saic� r_- �is z-�v E,Ss -�U� <br />CONTR�GTOR <br />OF WORN <br />WJRK �NO SOUARE FOOT�GE INVOLVED <br />�..��r ��� � _ <br />VROPOSED VSE OF BUILDING <br />LEGALDESCRIPTION OF RIOR <br />LOT BLOCK <br />TWO COPIES� <br />CONS7t1UCT10N IO�N IENDER. ADIX1E55. TELEI'MONE NUMBER <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ET <br />OR ITEM <br />SUBTOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBRCK REAR SETBACK SI�E SETBRGK <br />USE 20NE <br />NEIGMT LIMIT�TION <br />OCGUPANCV NO OFSn <br />GROUP <br />FlRE AUNM REO D <br />FIRE SPRINKLEP REG'D <br />ciTv <br />CITY <br />ZIP PHONE SiATE LICENSE / <br />ZIP PHONE STRTE LIGENSE � <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />WNTACT PERSON �ND PNONE NO. <br />I HEREBY CERTIFV THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COPRECT. ALL <br />PROVISIONS OF LAWS AND ORDINAN(:ES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHE?HEH SPECIFIED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV 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 PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTHACTORS LAW 1827 RCW AND 296200 WAC. <br />�� �� �/9 /�.� <br />SIGN�TURE � OATE <br />CITY BUSME55 LICENSE NO. <br />MECM�NICAL <br />NO. TYPE OF FlXTURE OR ITEM FEE <br />A/C — AMNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER NEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURI <br />FIREPLACE INSERT (WOOD BUF <br />FAN <br />LOTAREA VAGANTSITE �eeo <br />IlYES ❑ NO BUIl01NG <br />NO.OFOW[LLING 512EOFBlOG/Tl. <br />UNITS PLUMHING <br />OCCUPFNTLOAD BRSEMENT MECIIPNICAL <br />❑YES C7 NO <br />REASON <br />ADOIPONAL PLAN CHECK <br />OTNER <br />REASON <br />STATE BUII�ING SURLNARGE <br />PIANS RPPROVED BY CITY OF EVERETT �UBI IC WORNS <br />LOCALSALES <br />.,..� TAX CODE IS 3105 TOTAL <br />SUBTOTAL $ <br />PERMIT 8 <br />TOTAL FEE $ <br />FEE � PECEIPi N0. <br />