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APPLICATII,N FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAF' STREET • EVERETT, WA 9gp01 • 259-8810 <br />❑ DEMOLITION Cl COMBINATION �I BUILDING ❑ MECHANICAL f� pLUMBING f 1 SIGN <br />PROJECT ADDRESS <br />6512 Fleming Street <br />OWNER MAILA�DRE55 <br />V' _' 1 _ .. . . _ . _ <br />��TY Z�� PHONE <br />Cltt <br />ur <br />ARCHITECTORDESIGNER MAILADDR[5$ ��ry <br />Z��' PMONE <br />GENERALCONTRACTOR MAILADDRES$ ��ry Z�P � <br />PIIONE STATE UCENSE M <br />V'_'1_ .. .. _ . <br />CITV <br />��r PHONE <br />PLUMBINGCONTRACTOR MAILADDPE55 CIiV <br />Z�P PHONE STATE LICENSE � <br />n'tt'__ ..,. _ __ <br />$2850.00 <br />DESCRIBE WORKAND SOURRE FOOTAGE INVOLVED <br />oF <br />LOT BLOCN OF. <br />CONSTRUCTION IOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />PLUMBINU <br />NO. TYPE OF FUfTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WqSHER <br />URINAL <br />SUB TOTAL $ <br />PERMIT $ <br />HEATING SYSTEM: O GAS ❑ ELECTRIC ❑ <br />CONTACT PERSON FNO PHONE NO. <br />I HEREBY CEfiTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />coaies) 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 WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 qCW AND 2g6200 WAC. <br />SIGNAIUR`-�� �I L�FJI'L � <br />DATE <br />:ITY BUSINE55 LICENSE NO. <br />MECHANICAL <br />FEE NO. TVPE OF FIXTURE OR ITEM FEE <br />� A/C—q/HNDLGUNITS—H.P. , <br />; FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br />� HEAT PUMP � <br />i <br />' UNITHEATERS—B.T.U. M � <br />i CLO?I1ES DRYERS � <br />� <br />' VENTILATION FAN � <br />� RANGEHOOD � <br />� WATER HEATER � <br />' WOODSTOVE , <br />� METAL FIREPLACE lWOon auauitir.i � <br />i TOTAL FEE $ � <br />FOR OFFICE USE UNLY: <br />FRONTSETHRCK PERRSETBACK SIOESETBACK <br />USEZONE LOl'AREA VACANTSITE <br />❑VES CI NO <br />HEIGHT LIMITATION NO OF OWEILING SIZE OF BLDG/LI. <br />UNITS <br />OF <br />DATE <br />❑ VES fl NO <br />CITY OF EVERETT <br />LOCAI SALES <br />TAX CODE IS 3105 <br />FIiiEPU10E INSERT (WOOD BURNING) <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL $ <br />PERM�T $ <br />TOTAL FEE $ <br />ER � I FEE �O — I qECEIPi NO. <br />C <br />BUILDING <br />PLUMBING <br />MECHqNICAL <br />ADDI➢ONALPLANCHECN <br />OTHEF�3� Hedd6% <br />STRTE BUILDING SURCHARGE <br />PUBLIC WOPKS <br />TOTAL <br />