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APPLICATI�.N FOR CONSTRUC'� .ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMB�NG �Q SIGN <br />PROJECT ADDRESS / <br />91v�� �Jf�� ^r-F� �✓c�e <br />CITV <br />'�_�Pl1 Li/e0/ <br />MAIL <br />21P <br />PNONE <br />'YHONE - _ <br />iV //"� <br />CONTRACT PRICE OP WORK <br />Ji � �`= HEATING SYSTEM: CI GAS ❑ ELECTRIC O <br />DESCR19E WORK AND SOUARE FOOTAG WVQL�D_ CONTACT PEPSON AND PHONE N0. <br />— l��H�.,�� Fn.� ('o.__...,_ 2ct_ne�.� <br />r3i <br />e <br />LECAL DESCRIPTIIXJ OF PPOPERTY (SHOWN BELOW OR ATfACH TWO COPIES) <br />�or e�ocn oF <br />PARCELTAXI.D.NUMBER <br />CONSTRUCTONLOANLEN�'cR,ADDRE55.iE�EPHONENUMBEF <br />Al/A <br />PLUMBING <br />NO. TYPE OF FUCTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />_ KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTEFS <br />SINK (SERVICE — BAR. ETC.1 <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK RE�R SET6ACK <br />USE20NE _ � �OTAREA <br />� <br />HEIGHT LJMITFTION <br />SUB TOTAL S <br />PERMIT S <br />TOTAI FEE S <br />SIDE SETBACN <br />VACANT SITE <br />❑YES ❑ NO <br />1 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 OROINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE CUMPLIED 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 WURK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 FCW AND 296.20G WAC. <br />X ��.-� �� �� /c-SS <br />SIGNATORE �30�3'► DATE <br />CITY BUSINE55 LICENSE NO. <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />A/C — A/HNDLG UNITS — H.P. i <br />FORCED AIR SYSTEMS — B.T.U. M E.A. � <br />HEAT PUMP � <br />UNITHEATERS—B.T.U. M � <br />CLOTHES DRYERS � <br />VENTILATION FAN � <br />RANGEHOOD � <br />WATER HEATER i <br />WOOD STOVE � <br />METAL FIFEPLACE (WOOD BURNING) i <br />FIREPLACE INSERT (WOOD BURNING) � <br />GAS FIREPLACE ; <br />GAS RANGE � <br />GAS PIPING � <br />EXHAUSTFAN � <br />SUB TOTAL $ <br />PERMIT S <br />TOTALFEE 5 <br />PIAN CHECN NUMOER FEE I RECEIPT ND. <br />�,ni_ �_ 2�G�� <br />BUILOING <br />NO.OFDYlELUNG SIZEOFBLOG?I. <br />UNITS <br />PLUM�ING <br />OCCUPANTLOAD BASEMENT MECHANICAL <br />❑YES C7 NO <br />REASON ADDITIONAL PLAN CHECN <br />OTNER <br />HEASON <br />� STATE BUILDING SURCHARGE <br />PIANSAf�A,�OVEDBV CITY OF EVEREI"f PU�IIC WORKS <br />� ��r � LOCAL SALES <br />oare I I'.� 1� S � TAX CODE IS 3105 TOTAL <br />