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APPLICATIA FOR CONSTRUCI%N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •257-8810 <br />-. DEMOLITION COMBINATION i i BUILDING q MECHANICAL `l PLUMBING Islr.M <br />PROJECT ADDRESS �.F1 <br />4 48003 gas asa 3 373^• N+'. nCCnl',5 City -m <br />1'rg1N <br />'awAPT /1 fM4ADOPESS CITY Z" IYT]ME <br />ARCIKTE�CnTOyFI �CESf/iNEP LLAAAOMESS CITY .Ir IYAY. <br />OFFEIMICONTIYCIOR WAAOORESS CITY ZIP TMCME 6TAtE lASNSEF <br />f4CNAVCKQMMCip1 WLAppIC55 CITY IW R+JNL STAR LKENSE• <br />PIIAIBIIS LONTMCIpI YAAAOPIESS CITY ZN vlY STATELICENSEF <br />COIGII NICE Of WORK <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC <br />DESCRIBE WCRK AND SOMME fCCi INVOLVED <br />COMACT PERSONNA MIOFC Iq <br />PPrnosEo unaeuAOw <br />LEOUDEscPrtan DE EROPERTY IswWNBELOWq+AnACN IWV COPESI <br />ILO* BLOCK Of. <br />1 HEREBY CERTIFY THAT 1 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 PROVISIO14 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 THE WORK FOR WHICH <br />APPLICATION IS MADE AND i COMPLY WITH THE STATE <br />SLAW1B 27 RCW WAC. <br />7/11;,NTAACTOR..�296.200 <br />AO'1& <br />PARcu m 10 NUMBER <br />CONSTPUCTION LOAN LENDER, ADDRESS, IElER IAAABER <br />f ATE IT <br />CITY BUSINESSLCENSE NV <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />i <br />NC—A/HNDLG UNITS <br />BATHTUB <br />! <br />FORCED AIR SYSTEMS <br />I <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOL) BURNING) <br />I <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />! <br />FLOOR DRAIN <br />GAS FIREPLACE <br />F <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />I <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />i <br />I <br />I <br />SUB TOTAL S <br />SUB TOTAL S <br />PERMIT i <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE S <br />run urrRJt USt UNLT: <br />FRONT SETBACK <br />PEM 6ETBACR <br />SIDE SETBACK <br />FKAN CNECK MJMBER <br />FE <br />PECEIPI NO <br />USE LONE <br />LOT APCA <br />vACAxTSPE <br />❑rEs n xD <br />FEES <br />VALUATION <br />FEE <br />ellaDKu <br />HEIONLLnnPA1gN <br />TA OP OWELLEYD <br />B17EOP BlDOTI <br />�COUIpAHCY <br />MD Ci STCPfS <br />CCCINAMi IOW <br />BASFNENi <br />❑ YES ❑ NO <br />YECUMCM <br />FINLSI`AL ,LLRPEDD <br />REASDN <br />ADDIIWIAI PLW CIICOI <br />OTHER <br />FWEA4RUPEOD <br />PUEWI <br />STATE WRIP KE BUPE*I <br />TYPE Of COIST <br />PIMISAPPRDIrtDBr <br />DATE <br />CITYOFEVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />"CC WOPKs <br />TOTAL <br />