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APPLICATION FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />fl DEMOLITION <br />I I COMBINATION I I BUILDING II MECHANICAL PLUMBING SIGN <br />PROJECT ARESS <br />O <br />WNER NAIL ADDRESS L`Z <br />/' riry <br />DESCRI,16 WORK AND SQUARE FOOTAr•E INVOLVED <br />IS <br />---......_..........won'r WnvWN BIT <br />W WORT <br />LOT BLOCK l n <br />nF <br />TAx <br />i <br />NO. TYPE OF <br />WATER CLOSET <br />Z BATHTLIO <br />KITCHEN SINK & DISP <br />LAUNDRY <br />CLOTHES <br />URINAL <br />DRINKING <br />FLOOR OF <br />OR <br />SUB TO <br />3]t�� PERMIT <br />TOTALF <br />FOR OFFICE USE ONLY: <br />FRONT SFTRAC&c� <br />REAR SF r" .g <br />I ARE <br />4 <br />NO OF OWELLI NG <br />UNITS <br />NUMBER <br />FEE <br />V <br />q <br />PIIONE STATE LICENSE A _ <br />ZIP PIIONE STATE LICENSE-: <br />ZIP PHONE <br />SiaiE LICENSE . <br />1NG SYSTEM: I I GAS TVELECTRIC Fl <br />f PERSON 5N0 PHONE NO �- <br />2 �Z7�t 4 sz, 3 <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 />APPLICAN IS MADEw AND I COMPLY WIFE: THE STATE <br />CONTRA ORS LAW 18.2 W AND 296.200 WAC. <br />C� V CITY BUSINESS LICENSE_ <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />AIC—AMNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M E.A. I <br />HEAT PUMP ---i— <br />' UNIT HEATERS—B.T.U. M ,— <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD , <br />WATER HEATER ' <br />WOOD STOVE , <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT (WOOD BURNING) <br />GAS FIREPLACE -- , <br />GAS RANGE <br />GAS PIPING , <br />_ -� EXHAUST FAN — I <br />5 , <br />SIDE SETBAC K/ <br />PIANCIIEC N MRFR <br />s <br />.� <br />VACANT SITE <br />FEES <br />I IYES I I NO <br />BUII DING <br />IF RLDG?I <br />ZS SF IViU4 'f' <br />-G <br />Sf C-rAR.OGE <br />PLUMBING <br />BASEMENT <br />MF CRANICAL <br />IIYFS Imo' <br />__ <br />-- <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE S <br />'LU..L- 'C�Y:L�cLICe� <br />FFF - n5-1 RECEIPT NO <br />4 <br />Ij4' CITY OF EVERETT PUBLTr. WORKS <br />LOCAL SALES <br />DATE 10 2 TAX CODE IS 3105 TOTAL <br />