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APPLICATA FOR RCCONSTRUC: ON PERMIT <br />CITY OF EVERETT A BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 OL <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING trSIGN <br />GENERAL CIXIIMCIM - MAIL ADDRESS CITY I'll 111— 1.-1"...x. <br />MECMNICLL CGIIRACTOR MAR ADDRESS CITY ZIP PHONE SURE LICENSE <br />PLULAIINGCUNTRACTGT MAIL ADDRESS CITY ZIP PHONE STATE LCENSEA <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE MODB AND SGIARE FOOTAGE INVOLVED <br />CONTACT PERSON AW PHONE NO <br />I 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 PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGUTING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION, LTHA I AMAUTHORIZED BY HE <br />OWNER OF THIS PROPERTY TO PERFORM HE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 10.2 RCW AND 296.22000 WAC,C, g <br />/ l/ZI% NiiG / - /, - -7/ <br />PROPOSED USE DE BGLDIND <br />LEGALOESCRIPRONOr rmmEnlr lvamleElDw MAnrcu TwocwEsl <br />LOT BLOCK__ Of <br />jei(! As A" L4—T D <br />Pua:ELTAX E �/ <br />J -Cr%9' 012 �OCY> <br />CONSIAMPELI LOAN LENDER, ADDRESS. TELERIDNE LUMBER <br />X <br />DATE <br />CITY BUSII.ESS LCENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FlKTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A(HNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 8 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 (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT LW03D BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GASRANGE <br />SINK (SERVICE— BAR. ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL 5 <br />SUB TOTAL f <br />PERMIT $ <br />PERMIT f <br />TOTALFEE $1 <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FROIII SEICACK <br />REAR SETMCK <br />SIDE SETBACK <br />PI AN WECM NUMBER' <br />FEE�CO <br />99VALUATION <br />I1Ef.FIPI NO <br />USEZONE <br />IOTAREA <br />v1CANTSNE <br />OYES ❑ No <br />FEESf` <br />FEE <br />WIPING <br />�nZ <br />HEIGIRFNII.TION <br />NO OFU LUNG <br />SIZE OF&DYTI <br />UNI'i <br />n111M81ND <br />OCCUPANCI <br />GRDJn <br />WDSIMES <br />OCCUPANT LORD <br />BASEMENT <br />❑YFS ❑MO <br />4Ec"ANIM <br />_ <br />AfHMIX)MAL 1'IAN CHECK <br />i <br />T <br />FIRESPWNKLERMO'O <br />RMSM <br />DRIER <br />RREAWiMREOD <br />RHSDI <br />SIME BOILDIxf. 51111CHAMEEFEE! <br />C <br />� Cz <br />IlPF oc D,ONST <br />rinxSAPr Eo 6v <br />CITY OF EVERE17 <br />rUoJW.M." <br />I <br />1/ C� <br />DATE /(9 L <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />