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:. r " <br />i <br />� �� <br />APPLICATIV+d FOR CONSTRUCI.ON RERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION � BUILDINti ❑ MECHANICAL ❑ PLUMBING p SIGN <br />PROJECTADDRESS ___,. A l . nn . � .,. .n . ,. <br />��j��� ni�nuunes5 CITY ZIP <br />WyfC r✓� 4 _ Yil.. �._. �� �_ <br />��r.ik�'�ddt�F�(w Z%ti l�'1]e��,L �TT 46Zo1 ZS�i �163 <br />�RCHITECTOHDESIGNER qILAD�RE55 �ITY IIP PHONE <br />GENERALCONTRACTOR MRILADDRESS CITY 21P PHONE STATELICENSE� <br />�.�� 4Alai rSl.w ,F�i,�[ �(�! . P0. BA�G�G S+Artll�l�a 48�9 L �:y,�IG�z -3Sto r�u �r_� <br />MECHANICALCONTRACTOR MAILADDRESS CITY 21P PHONE STATELICENSE/ <br />�PUMBINaCONiRACTOR MAILADDRE55 CITY ZIP PHONE STATF.�ICENSE� <br />�.S Bt�'11 � <br />LEOAL DESCRIPjlON� PROPI <br />LOT BLOCN <br />HEATING SYSTEM: �IGAS � ELECTRIC ❑ <br />CONTACT PERSON ANO PMONE:JO. <br />I HEFEBY 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 COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />COPIES) NOT. THE GRANTING OF A pERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGUUITING CONSTflUCTION OR THE <br />R, • S� 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 COMPIY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />CONS7RlIC110N LO�N IENDER, ADDRE55, TELEPHONE NUMBER <br />PLUMBINO <br />NO. TYPE OF flXTURE OR ITEM FEE <br />WATER CLOSET (TOILE� <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 PREVENTERS <br />SINK (SERVICE — BAR, ETC.I <br />FOR OFFICE USE ONLY: <br />FROM SETBACN REAR SETBACN <br />� <br />USEZO E LOTAREA <br />HEIOHTLIMITATION NO.OFDWELLII <br />� � i UN115 / <br />/ <br />N 0 <br />s_ �. - <br />CITV BUSINESS LICENSE <br />MECHANICAL <br />NT TY! <br />A/C - AIHNDLG UNITS - H.P. <br />FORCED AIR SYSTEMS - B.T.U. M <br />HEAT PUMP <br />VEMIIATION FAN <br />RANGEHOOD <br />METAL FIREPLACE i <br />FIREPLACE INSERT <br />' GAS PIPING <br />� EXHAUSTFAN <br />i <br />SUBTOTAL $ ; <br />PERMIT $ i <br />TOTAL FEE $ � <br />SI�E SETBACK PUN CF�ECN NUMBER FEE <br />LOAD <br />VACANT SITE <br />fIYES NO <br />SRE OF BLDGR.I. <br />� ,4 Oo <br />❑ VES <br />'G <br />CONST. � PLANS A ROVED BY CRY OF EVERETT <br />� � nh LOCAL SALES <br />/ <br />ORTF c Z�_ 4 C TAX CODE IS 3105 <br />Bl11lDING <br />PWMBING <br />MECHANICAL <br />PDDIPONAL PLpN CHECK <br />OTHER <br />STATE BUiL01N0 SURCHARGE <br />PUBUC WORKS <br />TOTAL <br />TOTAL S <br />T.OTAL <br />PEE <br />