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APPLICATI Ni FOR CONSTRUCI i�1N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STRF:ET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ P!_UMBING IDI SIGN <br />OWNER <br />� <br />PLUMBINGCONTR�CTOR MAILADDRE55 <br />Cltt ZIP PHONE STATEUCENSE� <br />� <br />UAREFOOLIGEINVOLVE1� / <br />�,rj�7-, � <br />X � J /�O f.Vi'S7 ��"7 <br />7IN0 / <br />� f-f <br />o naoarvisuoWNBELOWORATTACHiWOC <br />ior e�oc�; <br />PMCELTN( I.D. NUM9Efi <br />�9 sa �vOd-po/- <br />CONSTRUCTONIORNLENDER.�DDRESS.TELEPNONS NUMBEfl <br />NO. TYPE <br />WATER CLJS <br />TFAY <br />FLOOR �R' �`1 <br />BACKFLOW PF <br />OR <br />FOR OFFICE USE ONLY: <br />FRONT SETHACX REAR SETBACK <br />� <br />HEIOMIT LIMITAiION <br />� <br />pERMIT <br />'fOTAL FEE <br />$ <br />SIUE SETBACK <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACTPEf150NANOP110N„N0. 7r�- w'Iri�.i <br />I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS <br />APPLiCATION AND KNOW THE SAME TO 6E TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OHDINANCES GOVERNING THIS TYPE OF <br />NOT THEIL(iRANTINGPOF A PERMIT DOES NOTEPRESUME TO GNE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHEP STATE OR LOCAL LAW REGULATINO CCNSTRUCTION OR THE <br />PERFORMAIJCE OF CONSTFiUCTION. THAT I AM AUTHORIZED BY THE <br />ppPLECA�IONHI SP MADET AND PER UMPLY EW H KTHE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />X ��!""� `� _ �/ C�� <br />SIGNATUFE OA7E <br />CITY BUSING55 LICENSE NO. <br />TYPE OF FIXTURE OR ITEM FEE <br />AIC —MiNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />HEA7 PUMP <br />� �N�7 HEATERS — B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WATER NEATER <br />WOOD STOVE <br />METAL FIREPLACI <br />FIREPLACC-INSEF <br />GAS FIREPLACE <br />GAS RANGE <br />QAS PIPING <br />FxHAUSTFAN <br />TOTAL <br />TOTAI <br />$ <br />PUNCf1ECKNUMBER FEE ,/^/D I�ECEIPiNO. <br />.�� i�n -� .0 V � <br />LOTAREA VACANTSITE <br />❑YES ❑ NO pUILDINO <br />NO.OFDWELLINi3 512EOFBLIXilT.I. <br />UNITS PLUMBING <br />OCCUPANTLOAD BASEMENT MECtI�NICAL <br />OYES ❑ N4 <br />ADpIP7NAL PtAN CHECK <br />REASON <br />OTrIER <br />REASON <br />�TATE BUIIDING Sl1RCHAfiGE <br />PLANSAPPROVEOBY CITY OF EVERETi' rueucwoaKs <br />/ � LOCAIS�LE3 <br />I..... � 2/q i)fi TAX COD►' IS 3105 TO7AL <br />