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ApPLICATIOrI FOR CONSTRUCT�ON PERMIT ' <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />Cl DEMOLITION fl COMBINATION f� BUILDING fl MECHANICAL �� PLUMBING f-1 SIGN <br />PROJECT ADDRESS � / � (J If��r <br />b li G (C�i�� Q1.S� <br />cm <br />ZIP <br />PHONE <br />ARCNITECT OR �ESIGNER MFIL ADORE55 CITY IIP PHONE <br />GENERRLGONTR�CTOii MnIIAUPRE55 CIiV ZIP PIIONE SfFTLLICENSE� <br />rT,�„� e��-n i,rs �o�-���� s� �� �gzo� .�s -a��� G�a�-rA1�T /oyK3 <br />MECHANICAL NTRACTOfi 1'i '.AD�RE55 CITV ZIP PIIONE STATE UCENSF <br />PWMBINGCONTRACTOR MAILA�DRESS CIN Z�P PHONE STATELIGENSE� <br />MAQ!ku�l �R �O1M-ns, 13315� se 3au NE Ar6�clew ��y23 y3555S5 I11�KyS���I J� <br />DESCRIBE WORN AN� S�UARE FOOTAGE INVOLVED <br />�pt BLOCN <br />CONSTRl1CT�ON LOAN LENOER. P��RE55. TELEPHONE NUMB[F <br />PLUM8ING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) ' <br />BATHTUB � <br />LAVATORY (WASH BASIN) � <br />SHOW ER � <br />KITCHEN SINK S DISP � <br />DISHWASHER ' <br />LAUNDRY TRAY <br />CLOTHES WASHER ' <br />URINAL � <br />DRINKING FOUNTAIN � <br />FLOOR ORAIN ' <br />BACKFLOW PREVENTERS � <br />SINK (SERVICE — BAR. ETC.) <br />SUBTOTAL S <br />PERMIT $ <br />TOTAL FEE S /J <br />FOR OFFICE USE ONLY: <br />FRONT SETPACN � PEAR SFTBACK SIDE SETBACK <br />USE20NE <br />IIEIGHT LIMITATION <br />OCGUPANCY NO( <br />GROUP <br />FIflE AIARM FEO'D <br />FIRF SPRINKIEfi P <br />TYPF OF f,ONST <br />LOTAREA <br />NO. OF DWELLING <br />UNITS <br />VACRNT SITE <br />f I YES f i NO <br />SIZE OF BLDGRI <br />�7vE5 �l NO <br />HEATING SYSTEM: Cl GAS fl ELECTRIC fl <br />CONTRCT PERSON FND PHONE N0. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TPUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />N07, THE GPANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PFOVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUGTION 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 AND 1 COMPLY WITH THE STATE <br />CONTRA T RS LAW 1827 R/�C�q(� D 296.200 WAC. <br />X �.�„ C° il'/��� , / ��C)�y�r <br />SIGNFTURE ��' <br />CITY BUSINESS LICENSE NO. <br />TYPE OF EOUIPMENT I FEE <br />NO. -- <br />A/C •— WFiNDLG UNRS — H.P. <br />FORCED AIF SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE ( <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />FAN <br />TOTAL <br />5 <br />$ <br />NUMOE(i FEE I RECEIPTNO. <br />BWLDMG <br />PLUMOING <br />MECNnNICAL <br />POOI110N�L PI�N G��F.f,K <br />OTNER <br />STAIE �UIl01NG SURLHARGE <br />CITY OF EVERETT �ueiir.�vonres <br />LOCAL SALES TOTAL <br />TAX CODE IS 3105 <br />