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�, ^, <br />APPLICATI`.N �FOR CONSTRUCI.ON PERMIT <br />CITY OF �JERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION Cl COMBINATION BUILDING ❑ MECHANICAL f� PLUMBING fl SIGN <br />PROJECT ADDRESS � S—�� � �� �v� <br />OWNER�VI • ��IGAI^SDRESS �� �7V �i �v/ ZIP /, �E 3�%/ � O 7 / <br />!�� 9Ys � <br />iENAMT <br />► <br />DESCRIBE <br />� <br />MAIL ADDRESS <br />MpILA0DRE5S � �/ <br />4l✓ " <br />���r/11L�ADD�RES�S� <br />�v • Y/ — <br />MAILADDRESi <br />LEOAL DESCRIPTIiNJ OF PROPEHTY (SHOWN BELOW OR ATTACH TN <br />LOT BLOCN �� <br />}}i1�5. �iv.—iM1. . o1Vm� io, i�t. <br />CONSTRUCTIONLOAN LENDER,ADDRESS,TELEPHONE NUMBER <br />PLUMBINO <br />NO. TYPE OF flXTURE OR ITEM <br />y WATER CLOSET (TOILEn <br />� BATHTUB <br />�j/ LAVATORY (WASH BASIN) <br />� SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTFAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FFE $ <br />FOR OFFICE USE ONLY: <br />FRONTSE7BACK REAR SETBACN <br />Zo� o � <br />USE ZON l0T AREA <br />55zS <br />HEIGHTLIMITATIO� Nn.OF�WELLING 5 <br />+� h / uurtc , <br />, n-I � � <br />FIRE P REO'D AEASON <br />� <br />FIRE S RINKLER REO'D REASON <br />S <br />1YPE0 CONST PIANSn <br />� DA7E � <br />SIDE SETBACK <br />CITV ]IP <br />FHONE <br />'"� �3�oa.�%''_ �-✓fE .ZS'P —�.f2._ <br />CIiY 71 � PHONG $TATELICENSEII <br />KINGST�I�IGL <br />CI1Y 21P PHONE STATE UCENSE 11 <br />FEE <br />ZIP PYGhE STAIE <br />HEATING SYSTEM: ❑ GAS fyELECTRIC f_'1 <br />. _ <br />f.0.',ITACT PERSON AND PHON� NO. <br />I HEHEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW "THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS ANU ORDINANCES GOVERNING THIS TYPE OF <br />VJORK K'ILL BE COMPLIEL 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 �ONSTRUCTION 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 7827 RCW AND 296200 WA� <br />X <br />SIGN URE DAT <br />CITY 9USINESS LICENSE NO. <br />MECHANICAL <br />NO. TVPE OF FU(TURE 6R ITE!' FEE <br />A/G - A/HNDLG UNITS - H � � <br />FOHCEDAIRSYSTEMS-B.T.U. M E.A. � <br />HEAT PUMP � <br />UNIT HEATERS - B.T.U. M ' <br />CLOTHES URYERS i <br />VENTILATION FAN � <br />RANGEHOOU � <br />WATER HEATER � <br />WOODSTOVE ' <br />A�ETAL FIREPLACE (WOOD BURNING) i <br />GAS (iANGE <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />� 9�. � <br />PLANCNE 1y.}�M� j�� FEE_��US REC��30�,� <br />H d �J <br />pR'ES ❑ NO Bl11LDING <br />BLOG/rl. <br />sf L�viu4 + pLUMBING <br />SF GAM4E <br />4SEMENT �� MECHANICAL <br />❑Yf:S N'NO <br />— AD�IiIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING Sl1RLHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />.� „ <br />/✓, � i <br />�� i <br />