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�-. -�. <br />APpLICATIG.� FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION f7 BUILDING � MECHANICAL ❑ PLUMBING Cl SIGN <br />PROJECT ADDRESS <br />OWNER <br />� � rc <br />ARCHITECT OR <br />-� <br />a <br />ZIP PHONE <br />� -/�27-ZZ7� <br />GENERALGONTRACTOR MAILADURE55 CITV ZIP PHONE STATELICENSE� <br />MECH�NICALCONTRACTOR MAILADDRESS CIN ZIP PHONE°.�G'/O OSTAtEUCENSE� <br />5W11 �"'�n �(F J�S�G�ns ��Q(� 5�� /�+Iil. �E /! tu �%���y �/�Tl:FS/if� <br />PIUMBINGCONTRACTOR MAILA�DHESS CITV ZIP PHONE STATELICENSEY <br />PRICE OF WORK <br />OESCRIBE WOFK ANO <br />r I ii <br />LEGAL OESCRIP710N OP PROPI <br />l0T 6LOCK <br />NUMBFR <br />FOOTAGE INVO W ED <br />CONSTRUCTIONLOANLENDER,ADDRESS,TELEPHONENUMBER <br />N0. TYPE QP <br />WATER ClOSET <br />BATHTUB <br />LAVATORY(WAS <br />SHOWER <br />KITCHEN SINK 8 <br />DISHWASHER <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE - BAR, ET <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC O <br />CONTACTPERSON�NDPHONENO. _ _ _ <br />I HEREBY CERTIFY THAT ! HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS O� LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WFiETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO V�OLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TI1E <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 AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />X <br />SIG RE �ATE <br />C BUSIYESS LICENSE NO. <br />MECHANICAL <br />OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br />� A/C -A/HNDLG UNITS - H.P. � <br />' FORCED AIR SYSTEMS - B.T.U. M E.A. ; <br />� <br />i HEAT PUMP � <br />� UNITHEATERS-B.T.U. M ' <br />� CLOTHES DRYERS i <br />SUB TOTAL 3 <br />PERMIT S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAR SETBACK SIOESETBFCK <br />USEZONE <br />HEIGHT LIMITATION <br />OCCUPAHCV NO OF51 <br />GROU <br />0.2�K� � <br />y <br />LOT AREA <br />NO. OF OWELLJNG <br />UNITS <br />R�EApS�OyN��,�.� I�y <br />✓fwNVl+N�7/ <br />VACANTSITE <br />❑YES ❑ NO <br />SIZE OF BLDGRI. <br />HANGE HOOD <br />WATER HEATER <br />WCOD STOVE <br />METALFIREPLACEi <br />F 9EPLACE INSERT <br />[��AS FlFEPLACE <br />GASRANGE <br />EXHAUST FAN <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />�J �UX / / I FEE �l / �� I RI/G/G <br />BIIILDItlG <br />3�yr�` PLUMBINC � <br />WY/ � <br />BASEMENT MECHANICAL i <br />❑VES J�NO � <br />A�OIPONPL PI.AN CHECK � <br />OTHER \ /1I1�0 A . � /. _ / � <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />STATE 9W101NG SUfiCH�RGE <br />PUBIIC WORKS <br />TOTAL <br />