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APPLICATIOti FOR CONSTRIaCTIvN PERNIIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •(425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRE/SS: �" : �� :S� ' � � � ��ALL (�� � p <br />�,-� �' rFt � n' c_ C / � � <br />� c%�i�n /.30/ �� �` zd r� _� A5 <br />�l'�1G� �5 •�TD.�c'S �'O�J �C'/,'t/�'�l � �r/%) ' � - %' - 0� - SCiU <br />tENANi <br />MNIA�URE55 GITY 21P PMONE <br />��ry ZIP �H0�1F <br />pqGNrt[Gi O� DESIGNER MRIL RO�RE55 <br />PLUMBINGCON1RAf,TOR MnILADDRESS GITY ZIP PHONE STATELICENSE� <br />GONiRACJiPfi10E,ry0F�tVOF1( � / I HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />�` /S,/,/ / � /�S I�S� I�' L� CONTACTPfR50N�NOPHO NO \2 �yq //n <br />OESCRIOEWORNANjl50UAAEFOOAGEINVOLVEO ���+�_ � ��, �.AA,, n��C�17SQs'7�/(�(-��,,(/'� �V�S� <br />PPOPOSED USE OF eUiLuirv� <br />IEGAL OESCRiPT10N OF F'OPE�N (SHOWN BELOW OR ATfRCH' <br />LO7 ULOCK OF <br />PARCELTR%1 NU ER U/ OOL� �/ <br />i�a� r�s�1 � y <br />CONSTRUG710N IOAN LEN�ER. A�DPESS. TELEPMONE NUMOER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />IAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URItv.1L <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTEFiS <br />cwu tRFRVICE — BAR, ETC.) <br />FOR OFFICE USE ONLY: <br />fRONtSFTAAGK REAR SETBACN <br />US[ ZONF <br />11EIG��� IIMItATION <br />OCCUPANCY NO C� <br />GROUP <br />FIRE SPRINNLER FEO <br />FlRE AIARM REU'� <br />rrae or r.o�+5i <br />� <br />� V►wff��" I HEFEBYJC�RTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO OE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br />wocoP�Est NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CAtJCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUGTION. THAT I AM AUTHOR�ZEO BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTR���LAW � CW AND 296.200 WAC. <br />% oeic <br />5!GNA UFE <br />CITV 9USINE55 LICENSE NO <br />SUB TOTAL S <br />PEFMIT $ <br />TOTALFEF S <br />NO. TYPE OF EQUIPMENT I FEE <br />�VG —wnnuw un <br />FORCED AIR SYSTE <br />HEAT PUMP <br />UNIT HEATERS <br />CIOTHES DRYERS <br />RANGEHOOD <br />$IOE SEIBACK � •'lpNG11ECrU�p�� n <br />� /L � <br />101 ARE� VRCPNt SIiE <br />❑vE5 ❑ N� Al➢lU'Nf <br />NO OF UWELUNG SIZE O� BLDGRI <br />��ry��$ FtUMOMG <br />Of.f.UPANiLO>� BASEMENI MFf:H�NIC/1 <br />❑VES ❑ N� <br />�D0IIIONN. Pl �N Glf CK <br />f1FASnN <br />O111ER <br />aFPSO`: <br />SiAIF. fl11I1���1G SIIfiCHMGE <br />rinNsnvrnovFoev CITYOFEVERETT runnr.wo��Ks <br />�L � LOCAL SALES TOTAL <br />OATE //�' rt� TAX CODE IS 3105 <br />SUB TOTAL $ <br />PERMIT S <br />TOTALFEE S <br />nFcemr Ho <br />