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APPLICATIO� FOR CG:.STRUCT�N PERMIT <br />CITY OF EVERETf • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />PROJECT ADDRESS <br />f 2�0 c.ic��_Qr=EN V,it�`( <br />Mm�nooness ��T <br />o�,E n ; . �i . . „ . .. i. � .,r , �� s�: <br />J C. /�.UJOI.�/� r"�— • v" — ZIP PHONE <br />7ENRNT MAILADORE55 ��TY <br />�raLv c \� i LL,eb�. <br />CITV ZIP PHONE <br />ARCMITECTOROESIGNER MAILADDBE55 q800S <br />cnv � o C�l�._.s�.n� ,4¢.� N. 18oS 13fo rc ry FL N.E ZB Ei—L�V v� HONE � 4 s�E c� � <br />GENERALCONTAAC`OR MAILAUORESS <br />P.o. Bo�cc�iY�1-3 <br />I�l'I�,�j Id-4 A�F. <br />Cln <br />OF <br />OcSCRIBE WORK pND SOUAflE F00T.1GE INVOLVED <br />...�-.-�� � ti�v. F�RE SPe <br />euaoiNo <br />�pT BLOCN <br />CONSTRUCTION LOAN LENUER. AODflE55, TELEPHONE NlIM8EI1 <br />PLUMBING <br />N0. 7YPE OF FIXTI <br />WATER CLOSET (TOILI <br />BATHTUB <br />LAVATORY (VlASH BA� <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENT <br />FOR OFFICE USE ONLY: <br />FfiONTSETOACK REAOF <br />HEIGHT LIMIiATION <br />ar <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACT PE�SON AND PMONE NO. <br />❑ SIGN <br />�r-n=s--�. � � <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO 8E TRUE AAD CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK W�LL BE COMPLIED WITH WHETHER SPECIFIED HEREIPI 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 REGULAT�NG CONSTRUCTION OR THE <br />PEHFORMANCE OF CONSTRUCTION. THAT 1 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 />CONTRACTORS R AND 296.200 YJAC. <br />X ����.� �� �� 7-� S <br />SIGNATURE OATE <br />CITY BUSINESS LICENSE NO. <br />OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br />, AIC—NFiNDLGUNITS—I�.P. <br />� FORCEDAIRSYSTEMS-6.T.U. M E.A. <br />� HEAT PUMP <br />� UNIT HEATERS — B.T.U. M <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE S <br />SIDE SETOACK <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />TOTAL <br />FEE <br />$ <br />ruNeiiec�,MC/�/O ree / . / I n[enrrno. <br />( �f <br />LOTA(lEA vn�nrvi ouc <br />❑YES p NO BUILOINO <br />NO.OFOWE�UNG SIZEOFBIDGR.�. <br />UNIiS PLUMBING <br />OCCUPANiLOAD BASEMENi MECHANICAL <br />❑YES ❑ NO <br />ADOITIONAL PIAN CHECK <br />flEASON <br />OTHER <br />REhSON <br />STATE DUILDIN6 SURCHARGE <br />PLANSAPPROVEDBY CITY OF EVEREI'f ruoucwonKs <br />�M LOCAL SALES <br />I..._.. 1�c,�9/� TAX COUE IS 3105 TOTAL <br />a <br />