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APPLICATIL.d FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />I 1 DEMOLITION i I COMBINATIUN IJ�BUILDING I 1 MECHANICAL n�� PLUMBING f 1 SIGN <br />PROJECT ADDRESS _ . _ _ .� i , �_ �,�j ; � <br />lOT <br />WORK AN� SOURRE <br />BLOCK <br />-OCt? <br />Mna ar.on�ss <br />MnIL ADDPESS <br />'� _ <br />INVOLVED <br />CONSTRUCT70N LOAN IENDER, AOOPE55. TELEPNONE NUIdBER <br />TYPE OF <br />CLOScTi <br />KITCIiEN <br />TRAY <br />WASHER <br />SUB TOTAL 5 <br />PEFiMIT 5 <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK �/ R[AR SETBRCK / <br />[� (% <br />USE:ONE � LOTARE� <br />�' <br />NEIGNTLIMIT�TIONn/J/ NOOFOWELUNG <br />� y) UNI15 <br />OCCUP�NC� hU O�SIOAiES OCCUPRNIl0A0 <br />TYPE OF CONST I PIAN <br />Vl� �/_ OATE <br />c�rv <br />>11 <br />� <br />r.irr <br />[Ml�i <br />�n♦ <br />FEE <br />� <br />ur <br />'�110NE STRiE LIGENSE � <br />L �S'o� u�v�r� 9�3�� <br />P110NE SiA7E LICENSE r <br />HEATING SYSTEM: F�Y�,AS f�7 ELECTRIC ❑ <br />C04TACi PFRSON ANDJ�' IOjJE NO <br />l � "L(o 7 °/ <br />I HEREBY CERTIFY 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 OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSiRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMFLY WITH THE STATE <br />CONTRACTORS LAW 1B 27 RCW AND 296200 WAC. <br />X� d�1- t��C.-- � 1 S- L 3•`I 's-' <br />SIGN�tURE O�TE <br />LITY BUSINESS LICENSE N0. <br />NECNANICAL <br />N0. TYPE OF FIXTURE OP ITEM FEE <br />A/C — A/HNDLG UNITS — H.P. � <br />FOPCEDAIRSYSTEMS—B.T.U. M E.A. � <br />HEAT PUMP � <br />inlir�-IFATFFA_RTII M ! <br />FAN <br />WOOD STOVE <br />METAL FIREPLAC <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SIDESETBACK / Purvu2c o nr.r. <br />VACPNi SIiE FEES <br />f7YE5 Il NO BNLOING - <br />SIIE OF OLDGRI <br />�'cf0 S��'. G vl/.l4 { pWM�ING <br />B�SEMENT �� MECN�NIC�L <br />fIYES f7N0 <br />PU�I110NAL PUN CNECK <br />OTI IER <br />STATE BUILDING SURGIIAfIGE <br />CITY OF EVERETT rueuc wonKs <br />LOCAL SALES <br />TA% CODE IS 3105 TO7AL <br />$ <br />TOTAL FEE <br />FEE//n0?IRECEIPTNO/ <br />Y � <br />