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APPLIGAi1C�' FOR CONSTRUC'i��- ���F,�IAIT <br />CITY OF EVERETT • BUILDING DIVISIO� i► U� � <br />3200 CEDAR STREET • EVERETT, WA 98201 •�39F�g�0 !1 <br />j�,d U <br />❑ DEMOLITION ❑ COMBINATION p HUILDING ❑ MECHANICAL OV ,�i`��81ZIBING �SIGN <br />CONiRnCiOR MAIL <br />MECN�NICAICONTRACTOR MAIADDRE55 <br />PIUMBINGCONTR�CTOR IAAILAODRE55 <br />DESCRIBE WORKANO SOUARE <br />LEGAL OESLRIPTIQY OF PPOPERtt (SHOWN DELOW q <br />�or oiocn oF_ <br />PMf,ELTA%1. NU BER <br />/ � �%� D/ �/' l7,� <br />CONSTRUCTIONLOANLEN�EP,F�DRESS.TELEPHONE <br />TYPE OF PIY,TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHEfi <br />LAUNDRY 1'RAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ETCJ <br />SUB TOTAL S <br />PERMIT $ <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONTSEiOACH REAR SETOACK� <br />� �' � <br />Ua'EZONE� LOT�REA <br />LIMIT�TILJ <br />cir� zm <br />, IU• `.�FYiI� 10 <br />CIIY I�P <br />cin zm <br />G�Y Zi!• <br />FEE <br />0 <br />SIOE SETOjCK <br />I�IY i <br />VACnNi SITE <br />❑YES fCRS <br />PNONE <br />3Z-0 0 0 <br />Pi10NE <br />VHOwE — <br />vNONE <br />STAtE LiCENSE � <br />STAiE UGENSE <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONiAGT PERSON AND4+IIONE NO •� n. . <br />I HEREBY CERTIFY TNAT I HAVE READ AND EXAMINEO THIS <br />APPIICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AN6 ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPIIED WITH WHETHER SPECIFIED HFREIN 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 REGULAiING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2E� BY THE <br />OWNER OF THIS P PERTY TO PERFORM THE WORK FOR WHICH <br />APPLICAT N IS A E AND I COMPLY WITH THE STATE <br />CONTR S 1.27 RCW AND 296200 WAC. <br />x l0 �27 Q� <br />SIGNRU E DAIE <br />CI fV BUSINE55 LICENSE NO. <br />NO. TYPE OF'c`�UIPMENT <br />A/C — A/HNOLG UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />MEfAL FIREPI.AC[ (WOOD BUR� <br />FIREPLACE INSERT (WOOD BURI <br />GAS FIREPLACE <br />GAS RANGE _ _ __ <br />GAS PIPiNG <br />EXHAUSTFAN <br />; SUB TOTAL S <br />, PERMIT S <br />��—�— __ TOTAL FEE $ <br />PUN CIIECN N7UM�ER /�, fEF 33 RECEIPT 1:0 <br />�l /., SV/ /� � <br />. U111101NC. <br />NO.OF DWEl4N� $IZE Oi OLDGRI <br />UN17S � P�Uu01NG <br />�/ <br />OCCUPANT LORf] OASEMENi MECNANICAL <br />❑YES O N9 <br />REASON AODIiICNAI. PLAN GMf.CK <br />Oi1 ER <br />REASpN - <br />/ $TAiE OUIl01N0 SIlRC11ARGE <br />rinNsnaPnovEoov CITYOFEVERETT ruonr.wonKs <br />I/ LOCALSALES <br />�..E "�.. � n TAX CODE IS 3105 TO"iAL <br />FEE <br />