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APPLICAT11,rV FOR CONSTRUCI.ON PERMIY <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />f—I DEMOUTION fl COMBINATION f� BUILDING fl MECHANICAL f � PLUMBING f� SIGN <br />IPROJECTADDRESS � <br />059N[R MNLADORESS <br />cirv zm <br />�� <br />ARCNITECTORDESIGNER MAILAD�RE55 Citt ZIP PNONE <br />GENEflALCONTRACiO(� MAILA�DRf:55 QTV ZIP PIIONE <br />I..int..� AA�...__ Jil_ . � __ . �. . . STATEUCENSE� <br />PLLIMBING <br />AND SOUARE FOOTRGE <br />LOT � gLOCK _1� <br />�!UlSIGN #/ <br />¢8'D�DOBQ/I O 1 O l <br />CONSiqUCTION LOAN LENDER. ADf1RE5S. TELEPMONE NU6IBER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BAl'HTUB <br />� LAVATORV (WASN BASIN) <br />SHOWER <br />KITCHEN SIN{ 8 DISP <br />LAUNDRY TR�IY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PFtEVffNTERS <br />SINK fSERVICF� — Rna F7 <br />SUB TOTAL <br />TOTAL FEE <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK' FEARSEGACK <br />1�0 �p � <br />�USEZ E LOTAREA <br />� <br />HEIGNTLIM N� NO OFDWELLING <br />� UNITS 1 <br />I�P PIIONE STATE LICENSE • <br />Z�P PNONE STATE UC NS r <br />HEATING SYSTEM: fl GAS fS�LECTRIC ❑ <br />CONTACT PERSON �N� PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND K�OW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS'lYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />nvocoaies,l�y- NOT. THE GRANTING OF A PERMIT DOES tdOT PRESUME TO GIVE <br />D ��'( 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 AUTHORI2ED BY THE <br />OWNER OF THIS PRO�'ERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WqC. <br />� <br />x J 4����SS <br />SIGYATURE 04 E <br />CITY BUSINE55 LICENSE NO. <br />FEE NO. TYPE OF FIXTURE OR ITEM FEE <br />' A/C—A/HNDLGUNITS—HP. <br />; FORCED AIR SYSTEMS — B.T.U. M E.A. <br />� HEAT PUMP — <br />' UNIT HEATERS — 9.T.U. M <br />� CLOTi1ES DRYERS <br />S <br />SIDE SETBACK <br />5� <br />VACANTSIfE <br />nres �-i5G <br />SIZE OF 9LDG/Tl. <br />� 7�G <br />BASFMENi � � <br />f]YES M1'NO <br />VEfdTILATION FAN <br />RP.NGE HOOD <br />WATER HEATER <br />METAL FIREPLACE <br />FIREPLACEINSCF� <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />PLAN <br />ouaowc <br />PlUM01N0 <br />MECMANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />:IER PEO'D REASON <br />Q STATE BOILDING SURCN4RGE <br />NST. PLANS APPROVED BY CITY OF EVERE7T PUDLIC WORKS <br />J .^ LOCAL SALES <br />IJ onre 5�� TAX CODE IS 3105 70TAL <br />SUB TOTAL S � <br />PERMIT 5 � <br />TOTAL FEE S —�- <br />FEE RECEIPTNO. <br />.� <br />VALUATION FEE �y <br />R t9 I t., ��%lf : — <br />