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APPLICATIOrI FOR CONSTRUCT�ON PERMI`T <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-�,810 <br />f7 DEMOLITION fl COMBINATION fl BUILDING I� MECHANI„AL KFPLUMBING f, SIGN <br />PROJECT ADDRESS „ � _ i •1 <br />cirv <br />TENANT MAILADDRESS CITV 21P PMONE <br />ARCMITECTOR�ESIGNER NAILADDRE55 Gltt 71P PNONE <br />(iENEMLWNTRACTOR MMLAODRE55 CIiV ZIP PIIONE SiAiEUC[NSE� <br />.__....._.."-......."•".. •••^••"""'^"' uiT ZIP PIIONE STATELICENSEY <br />PLUMBINGCONTRACTIXi MAIL�DDRE55 CIIY ZIP PIIONE STATELICENSE� <br />�c�� <br />LOT _ <br />f ^FRICE pFJy(7pK <br />✓0 �r� <br />WORKANDSOUAREFOOTAGE <br />BLOCK <br />5 � <br />Tn <br />HEATING SYSTEM: f l GAS f� ELECTRIC rl <br />CONTACT PERSON ANO PHONE NO. <br />FT" I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. qLL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />1CMTWOCOPIES) NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOCAL LAW REOULATING 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/JCOMP Y WITH THE STATE <br />CONTf�ACTORS LAW 1827 RCW jcT�►0/2962�WAC. <br />CONSTi1UCTION LOAN LENDEH.IIDDRE55, TELEPHONE NUMBER <br />TVPE OF <br />WATER CLOSET <br />LAVATORY <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTE <br />SINK (SEHVICE — BAR, <br />FOR OFFICE USE ONLY: <br />FRONT SETBACN RE�R SETBACK <br />USE ZONE <br />NEIGHT LIMITATION <br />REO'D <br />SUB TO' <br />PERMIT <br />C� BUSINE55 UCENSE NO. <br />IECHANICAL <br />NO. TrpE <br />A/C —NHNDL <br />FORCED AIR S <br />HEAT PUMP <br />— B.T.U. M E.A. <br />UNI' HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />WATEF HEATER <br />WOOD STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS PIPING <br />EXHAUSTFAN <br />$ <br />a <br />SIDE SETBRCN � PIAN CNECK NUM9ER <br />LOTAREA V�C�NTSIiE FEES <br />f1VES ft NO pUILDWG <br />NO.OF�WELLING $IZEOFBLOGRI <br />UNI�S <br />PLUMBING <br />OGCUPANTLORD BASEMENT MECl/ANICRL <br />IIYES I1 NO - <br />HF.RSON /DO1710NAL PLr1N G��F.CK <br />OTHER <br />REASON <br />^_•TATE 9l➢IDING SURGH4qGE <br />PIANSAPPROVEDBV CITYOFEVERETT �uaur,wonKs <br />LOCALSALES -- <br />onTE TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FEE I AECEIPT NO. <br />