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APPLICATIC@ FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •257-8B10 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />CONTAACT PRICE OF Y W <br />QaQ. <br />HEATIN SYS E ❑GAS L3tLECTRIC ❑ <br />OESC W ANNSWARE FOpiA ENYOIYED <br />;D <br />Cp1iACT1 n50N Ip. <br />VC z Z <br />I HEREBY 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 ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED 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 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 />CONT ACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X (\l ICJ 14 1rN/�� <br />MgeOSED USE OF BVEOBq (J <br />I\ <br />LEGALDESCRWTMOF P1 ERW SNOWM BELOW OR AilACN 1YlO LOPIE51 <br />LOT BLocK OF <br />5��' <br />PARCELTAX I.D. Nu BER O� <br />� � o� oas <br />CONSTRIICIIONLOANLENCER.ADpTES9.TELEPrgN¢MIMBER <br />SAINAIURE DATE —i <br />_PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />CITY BUSINESS LICENSE N0. <br />MECHANICAL <br />NO. TYPE OF EOI!IPMENT FEE <br />WATER CLOSET (TOILET) <br />A/C —AtHNDLG UNITS <br />i <br />BATHTUB <br />! <br />FORCED AIR SYSTEMS <br />! <br />i <br />j <br />LAVATORY (WASH BASIN) <br />I <br />j <br />j <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />SHOWER <br />KITCHEN SINK A DISP <br />DISHWASHER <br />•I <br />RANGE HOOD <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />j <br />WATER HEATER <br />WOOD STOVE <br />! <br />METAL FIREPLACE IWOOD BURNING) <br />! <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />13ACKFLOW PREVENTERS <br />! <br />GAS RANGE <br />SINK(SERVICE —BAR, ETC.) <br />! <br />GAS PIPING <br />_ <br />I <br />j <br />EXHAUST FAN <br />I <br />I <br />SUBTOTAL S <br />i <br />SUBTOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />TOTALFEE <br />FOR OFFICE USE ONLY: <br />S I <br />TOTALFEE $ <br />FRpNT SETBACK� J <br />PEMSETTIACKr <br />C <br />SICE SETBACK <br />CI,ECO R/- <br />91.1J J6 <br />FEE n� �O <br />IVALUATION <br />nECEinihO <br />USE zom / <br />LOi APEA <br />vACANt Sim <br />OYEs O No <br />FEES <br />FEE <br />BU,La,IO <br />IB '�JP <br />"EIGHT HMITATgN <br />NO OFDWRLRID <br />UNITS <br />SMEOFBLO t <br />33S S <br />I+NLIBINR <br />OFSRS <br />Z <br />f,RE SPRINALER nEOD <br />nR[MARM REOD <br />OCCWMTLOD <br />BASEMENT <br />DYS i/ <br />MECIIANWW <br />AWRgNAL PUNCNECR <br />REASON <br />ODIER <br />nEASon <br />STATE BV0.011q 6UFAunOE <br />TYPEOFCONST. <br />a SAPPROVJWCy <br />ow 2. GL �cj <br />CITYOFEVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />mam,on,,s <br />— <br />j <br />TOTAL <br />