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- ,-. <br />APPLICAT14.�1 FOR CONSTRUC7.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA ggp01 • 259-8810 <br />❑ DEMOLITION fl COMBINATION fl BUILDING I�l MECHANICAL I� PLUMBING f-1 SIGN <br />PROJECTADDRESS � �/D �r /e�� � .,A/U� <br />1 /�/ <br />CONTRACT PRICE OF WORK <br />'� v C �- <br />i0T BLOCK <br />; No_ 3vz �0,5•- 3_ <br />�� <br />CITV <br />aTv <br />255 CITV <br />a <br />v=J - 91l �a� = gC <br />` �� 5 f�. ' Sf <br />T� f/l� <br />iLOW OR ATTqCH T`NO COPIESj <br />OF <br />�?�-0009 <br />CONSTflUCTION IOAN LEN�EP. A�DRE55, TELEPHONE NIIMBER <br />NO. � TYPE OF FlXTURE OR ITEM <br />:i:.: ER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAV <br />/ CLOTHES WASHER <br />� URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FROM SETB� , REAq SE�T9A�CN• , <br />c„fJ <br />USE20NE LOTAREA <br />�✓ � <br />HEIGHTIJMITATION NOOFDWEILING <br />� �..� � UNITS <br />� <br />� � I OATE �'S I <br />�SZ�/ �� -�v36- <br />ZiN PHONE <br />�'__ ���. <br />STATE LICENSE � <br />�-_ <br />STnTE UCENSE � <br />Y <br />HEATING SYSTEM: �1 GAS ❑ ELECTRIC ❑ <br />CONTPCT PEPSON AND PHONE N0. <br />I HEREBY CERTIFY THAT I NAVE 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 PERMIT DGES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEI. 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 WORK FOR WHICH <br />APPLICATION IS MADE AND I CGMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296:200 WAC. <br />! <br />a��� 2 �-?�s —>�" <br />GNbTUF ORTE <br />CITY 9USINE55 LICENSE NO. <br />FEE NO. TYPE OF FIXTURE OH ITEM FEE <br />� PJC —AMNDLCa UNITS — H.P. <br />; FORCED AIR SYSTEMS — B.T.U. M E.A. <br />� HEAT PUMP <br />' UNIT HEATERS — B.T.U. M <br />� CLOTHES DRVERS <br />� VENTILATION FAN <br />i RANGE HOOD <br />� VVATER HEATER <br />' WOODSTOVE <br />� METAL FIFEPLACE (WOOD BURNING) <br />� F�REPLACE INSERT (WOOD BURNING) <br />; GAS FIREPLACE <br />� GASRANGE <br />' GAS PIPING <br />i EXHAUST FAN <br />SIDE SETBACy� <br />S� <br />VRCFNTSITE <br />❑ YES ❑ NO <br />SU8 TOTAL $ <br />PERMIT S <br />TOTALFEE $ <br />PIANCNECNNUMBER I FEE �y I RECEIPTNO. <br />BUILDING <br />SIZE OF BLDGR.1. <br />4 PLUM9ING <br />BASEMENT � AIECHFNICAL <br />❑YES ANO <br />A�OIPONAL PLAN CHECK <br />OTNER <br />STATE BUILOING SIIRCHr1R0E <br />CITY OF EVERETT PUBLIC WORNS <br />LOCALSALES <br />TAX COUE IS 3105 To7AL <br />