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APPLICATIG� FOR CONSTRUCT�dN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION Cl BUILDING ❑ MECHANICAL I� PLUMBING rl SIGN <br />PROJECT ADDRESS <br />MML <br />cirv� i��r1 <br />� � fl LU.�L <br />cirr nr <br />o�//v <br />�, <br />GENERPLCONTRAC70R MAII.ADDRE55 QTY 21P PHONE STATELICENSE� <br />MECHANICALCONTRACTOR MAILADORESS CITY 21P PIIONE STATELICENSE� <br />LOT <br />PAqCELTAX <br />BLOCK <br />INVOLVED <br />CONSTFUCTION IOAN IENDEA. A�ORE55, TELEPHONE Nl1M0ER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASIi BAS�N) <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />CLOTHES <br />URINAL <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAfl. ET <br />FOR OFFICE USE ONLY: <br />FRONTSETOACK REARSETOACK <br />USEZONE <br />HEIGNT LIMITATION <br />LOTAREA <br />TK'O COPIES) <br />rnurvt <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACTPERSONANDPNONENO. <br />I HEREBY CERTIFY THAT I 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 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 A�SD I COMPLY WITH THE STATE <br />CONTR TORS LAW 78/.2//Z/ RCW AND 296200 WAC. <br />SIGNA� �•t�JC_ \ X�/)/f��C� � / • LJ <br />�—V <br />CITV B1151NE55 LICENSE NO. <br />FEE NO. TVPE OF FIXTURE OR ITEM <br />� A/C—AMNDLGUNITS—H.P. <br />; FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />� HEAT PUMP <br />! UNIT HEATERS — B.T.U. M <br />SUBTOTAL 5 J ; - <br />PERMIT S � <br />TOTALFEE S ��, ' <br />SIDE SET6ALK <br />NO. OF OWELLI�G <br />UNITS <br />OCCUPANTLOAO <br />VACANT SITE <br />❑VES ❑ NO <br />SIZE OF OLDWTI. <br />VENTILATION FAN <br />RANGEHOOD <br />WOODSTOVE <br />METAL FIREPLACE I <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />SUB TOTAL S <br />PERMIT S <br />TOTAI FEE S <br />PIANCHECKNUy�DEiy� I FEE � AECEIPTNO. <br />UOILOING <br />PLUMOING <br />\SEMENT MECHANICAL <br />❑YES CI NO <br />ADDITIONRL PLAN CNECK <br />O7HER <br />S7ATE BUILDING Sl1RCMARGE <br />CITY OF EVERETT PUBLIC WOFlKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />