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APPi.ICATI('� F�R rONSiRUC'i��l P�F��+11�' <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET � EVERETT, WA 98201 • 259•8810 <br />I] DEMOLITION ❑ COM8INATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING p SIGN <br />PROJECT ADDRESS: 7GJ� CJetq J <br />C.� <br />-?22 -�3!/ <br />ZIP PIIUNE <br />ARCMREGT ON OESIGNER M�II AODf1E55 CITY 7iP P110NE <br />GENEOFICpNi(I�C70q MAIIADORE55 LIIY 71P PIIONE Sf�TGLICENSE• <br />MECIIAHICALCONTMCTOf1 MAllA0DRE5S CITY pIP PIIONE STAi�IICENSE� <br />�M�s��lle �P1�,6;Nrti, 1331e �� 5'3o N� A�-1 y'�z2z3 y�s ss s M� so� /�l,Tt <br />Plu1ABINYCONiR�CTOR � MAILAUDPE55 CIfY IIP PIIONE STAiELCENSE� <br />PRICE <br />OESCOIBE WORN AN� SOU�RE FOOTAGE <br />IEWL OESCRIPTION pF PROPERiY (SIIOWN BEIOW qi ATfAGH TWp LppIES� <br />LOT OLOCN OF— <br />PARCEL <br />CONSTRUC710N LOAN IEN�ER. ADDRE55. TELEPf10NE NUMBER <br />NO. TVpE OF <br />WATEF CLOSET <br />BATHTUB <br />LAVATORYIWAS <br />KITCHEN SINK 8 DISP <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DP,INK�NG FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN' <br />SINK (SERVICE — an <br />OR ITEM <br />SUB TOTAL <br />FEE <br />PERMIT $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAR SETDA�K SIDE SETOA�N <br />USEZONE IOTAREA VACANfSIIE <br />❑YES ❑ NO <br />HGIGIIT LIMI7ATION NO Of DWELUNG SIZE OF OLDGR.I <br />UNIi$ <br />OCCUPANCY H00[SI011If5 OCCUPAHilOAO BASEMENi <br />FIRE SPFINKLEfi REO'D <br />D�TE <br />❑YES ❑ NO <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACT PFNSON AND PHONE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPIICATION AND KNOW THE SAME TO BE TfiUE AND CORRECT ALL <br />PqOVIS�ONS OF LAWS PND ORDINANCES GOVERNING THIS TYPE OF <br />WOPK WILL BE COMPLIED WITH WHETHER SPECIFIED HF.REIN 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 REGULATING CONSTR�ICTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THA71 AM AUTHJRIZED BY THE <br />OWNER OF THIS PROPERTY TO PEFFORM THE WORK FOR WIiICH <br />APPLICATION IS MADE AND I COMPLY W�TH THE STATE <br />CONTR ORS LAW 1027 RC D 296.200 WAC. <br />x / %G,vr � ' ,/�, ) ����/�j',� <br />SIGNATUIIE I p�T <br />CIN BUSINESS LICENSC NO. <br />NO. TYPE OF EOIIIPMENT <br />A/C—AMNDLG UNRS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER IIEATER <br />' MEfALFIREPLACE(WOODBURNING) <br />� FIREPLACE INSERT (WOOD BURNING) <br />� GAS FIREPLACE <br />; GAS RANGE <br />GAS PIPING <br />� EXHAUST FAN <br />� <br />� <br />; SUB TOTAL 5 <br />� PERMIT E <br />' TOTAL FEE S <br />PUNCIIECNNUMOE9 FEP R'cf.EIPiNO <br />53 n <br />I FEES VALUATION <br />Ol11lD�N(: <br />P1U6101NG <br />MECHnhICAL <br />ADDI110NRL Pl4N LNf:CK <br />OillEfi <br />$TAIE OUR�IN6 SIIDCIIAIiCE <br />CITY OF EVERETT rumicwonKs <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />FEE <br />