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APPLICATIO.� FOR CONSTRUCT�JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />� DEMOUTION fl COMBINATION f-1 BUILDING I� MECHANICAL rl PLUMBING fl SIGN <br />2z S (a/�--yL4 <br />_ . ._..__......., I:IIY <br />zir r��oue <br />� . , `r `,.TM.� /:_., -,.�� +�-� - l�,�.4„�,n�- ) ,., .�n...-T <br />a�i$ V•• V MAILADORESS CI1Y ZIP PHONE S3• �p' _ A,q3 <br />��w�s Sc�ln1����x 1613 k"nC,t�xoo�eLN,�.Il�72Ei'T 98203 347g�v� N,�� <br />OROESIGNER MAILAODRESS ��... _._ __. <br />NC `f g�o7 zizu�st�sE. <br />�VQ�Bp �. <br />� -�• rrvnc STATE LICENSE � <br />PLUMBINGCONTRACTOR M�ILADDRESS CITY ZIP PHONE <br />$TATE UCENSE � <br />88�0,�� <br />WORK ANO SOUARE FppT�GE INVOLVED <br />T <br />LOT BLOCK <br />PARCELTN(LO.NUMBER �g�z_ oo -�7_�0� <br />�-�R�2:-c 0�1 -c� � -oo� <br />CONSTAUCTIONLORNIENDER,ADDRE55.T�LEPNONENUMBER <br />PLUMBING <br />NO. TYPE OF flXTURE OR <br />WATER CLOSET (TO�LET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNDRYTRAY <br />CLOTHES WASF <br />FLOOR <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />fRONTSFTBACK PEnR SETOACN <br />USF2CNE <br />lIEICI{T LIMITATION <br />LOTAq[A <br />NO OF DWELLING <br />UNITS <br />SIDE SETBACK <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONT�Ci PERSON AND PHONE NO. <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 pERM1T DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br />PEFFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITIi THE STATE <br />CONTRA T 5 LAW 7827 RCW AND 296200 WAC. <br />x —,� L�'�� ;—"-�--� _ la-la -�i�f <br />SIGNATURE � � ORTE <br />CITV BUSINE55 UCENSE N0. <br />FEE NO. TYPE OF FIXTURE OR ITEM <br />' AIC—A/FiNDLGUNITS—H.P. <br />; FORCEDAIRSYS?EMS—B.T.U. M E.A. <br />� HEAT PUMP <br />' UNIT HEATERS — B.T.U. M <br />i CIOTHES DRYERS <br />� V[NTILATION FAN <br />� RANGE HOOD <br />� INATER HEATER <br />' WOOD STOVE <br />i METAL FIREPLACE fWOOD 9liRNWl;� <br />VACANT SITE <br />f7YE5 fl NO <br />SIZE OF bLDG/fl. <br />❑VES fl NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />PUN CHE,C^K `NO,M.f1FR <br />�(5/Y �` <br />OUILDMC <br />PLUMUING <br />MECII�NICAL <br />ADDI110N4L PLAN CHECK <br />OTI/ER <br />STATE BUILDING SURCNARGE <br />PUBI.IC WORKS <br />70TAL <br />SUBTOTAL S <br />PERMIT 5 <br />TOTAL FEE $ <br />FEE RECEIPT Np. <br />