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APPLICATIG./ FOR CONSTRUCT _ �N PERMIT <br />CITY OF EVERETT • �UILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />f7 DEMOLITION f l COMBINATION f-] BUILDING f 1 MECHANICAL PLUMBING fl SIGN <br />PROJECT ADDRESS � <br />.,`, J. �;..; 7't�Y �vv�'r'. z-rr ��' ���: � o I <br />OVMER MAILROOFLSS CITY " ZIP PNONE <br />. � . , ti � . <br />� .�%• <br />MAIL ADORESS <br />�G � <br />'//Y.L1 <br />GENERAL CONTRnCTIXi MAIL �DORE55 CITY ZIP PNONE SiATE UCENSE � <br />MECNANICALCONfRACTO{i MMINDDRE55 CITV 21P PHONE STATELICENSE� <br />PLUMBING WNTRRCTOP MRIL ADDHESS CITY ZIP PHONE STpTE UCENSE � <br />� HEATING SYSTEM: f J GAS ❑ ELECTRIC fl <br />WOFKANU SOURRE FOpTq�F. INVOLVED �� CONTRCT PEPSON AND PIIONE NO. <br />rL �1��`.� � Y/ ��� �jcf �� I HEREBY CERTIFV THAT I HAVE FEAD AND EXAMINE� THIS <br />PPOPOSED USE OF Bl11lAIN0 APPL�CHTION 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 />LEGRlUESCRIPTIONOFPROPERTV(SHOWN9ELOWOfIRTTACHTWOCOPiES) ;;pr. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />ior etxK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCT!ON OR TNE <br />PE.RFORMANCE OF CONSTRUCTION. THAT I AM AU7HOFI2ED BV THL <br />O'NNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />A?PLICATION IS MADE AND I COMPLV WITH THE STATE <br />PARCELTA%I.D.NUMBER C.�N7R CTORS LAW 18.27 CW AND 296.200 WAC. <br />CONSTRUCTIONLOANLENUER.AODRESS,iEV7NONENUMBER x jH •/�./� (�.,�' �/��y^ <br />SIGNATUPE DATE <br />PLUMBING <br />NO. TYPE OF FIX7URE OR ITEM <br />WATER CLOSET (TOILET) <br />BFTHTUB <br />KITCHEN SINK 8 DI5P <br />DISHWASHER <br />LAUNDPYTRAY <br />CLOTHES WASHER <br />DRINKING FOUNTAIN <br />FLOOF DRAIN <br />BACKFLOW PREVEIJI <br />S�NK (SERVICE — BA <br />SUD TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />�r'J <br />FOR OFFICE USE ONLY: <br />fRONT SETBACN REARSETBACN SIOESETBACK <br />USE ZONE <br />HEIGNT UM;TATION <br />OCCUPANCY NO Of <br />GROUP <br />IOTRPER <br />NO OF OWELLJNQ <br />VNITS <br />FLAtJS <br />VACPNi SIiE <br />f1YE5 ❑ NO <br />SIZE OF BLDl3/T.1. <br />❑YES ❑ NO <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />CITV BUSMESS LICENSE N0. <br />N0. TVPE OF FIXTURE OR ITEM <br />A/C — NHNDLG UNI7S — H.P. <br />FORCED Alp SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — �.T.U. M <br />CLOTH�S DRYEP.S <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD OURI <br />FIREPLACE INSERT (WOOD BUF <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />AUILDINO <br />PLUMOINO <br />MECHRNICAL <br />R�DITIONRL PIAN CMECK <br />OTHER <br />S7ATE BUIL�INO SUACMARGE <br />PUBIIC WORKS <br />TOTAL <br />SUBI�OTAL S <br />PERMIT $ <br />70TALFEE $ <br />RECEIPT NO. <br />FEE <br />