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APPLICATIA FOR CONSTRUCAN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET P EVERETT, WA 98201 • 257-8810 <br />17 DEMOLITION COMBINATION f i BUILDING MECHANICAL -I PLUMBING SIGN <br />(PROJECT ADDRESS SOI< F�QCeA_� <br />n111. Il.IL TKE55 CITY Z" l ang1E <br />APCHRECT OR DESIGTER WVLADDRESS CRY ZIP PHCIIE <br />OENERALCDNiRAGIdI MARADdTESS CRY ZIP PIIDIK STATE MENSEP <br />�g2s•7��-4gei a) / J 5 P/D- 1)14 .Tk <br />COMTMCi PPOE Df WDM( <br />HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br />OE <br />WORK $WADE iDDIAGE IINpYED <br />OON1ACi PERSONAW PIgNEW <br />1 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 />CCONTRACTORS LAW 18...2277,yRCC. I AND 296.200 WAC. <br />4 <br />yY �Y [ /✓` <br />NATURE DATE <br />PROPOSED USE GP BIRIDING <br />LEGAL M%RPION OF PPOPERTY ISWWN BELOW OR ATTACH IWOCCPRSI <br />LOT BLOCK a <br />PARCEL TAIL 10 NUMSER <br />I ER <br />CCRUC STRTIDNAN LOLENDER, ACENGTI ES& YEMPIIE MLIB <br />CITY BUSINESS LICENSE W. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />AID — AHNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) 7 <br />HEAT PUAIP <br />SHOWER <br />j <br />UNIT HEATERS <br />i <br />KITCHEN SINK d DISP <br />i <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />i <br />RANGE HOOD <br />LAUNDRY TRAY <br />I <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />j <br />METAL FIREPLACE (WOOD BURNING) <br />j <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />I <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />I <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />I <br />I <br />EXHAUSTFAN <br />I <br />I <br />I <br />i <br />I <br />SUBTOTAL S <br />I <br />SUBTOTAL S <br />PERMIT S <br />I <br />PERMIT S <br />TOTALFEE S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: )c (j()D2-b I I <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PIATICHECNWMBER <br />FEE <br />RECEIPT AID <br />um ZONE <br />LGEAREA <br />VACANT WTE <br />❑YFS ❑ W <br />FEES <br />VALUATION <br />FEE <br />BURdW <br />HEIGHTLIMITATION <br />W aCWELLMG <br />UMTS <br />SIIEOF&OGTI <br />PLL)"m <br />OCCUPANCY WOF STDPEE <br />GRWP <br />OCCUPANT LOAD <br />BASEMENT <br />OYES Ow <br />MELNAMCAL <br />ADDIfONALPIAN CNECK <br />FPESPRINKLENREOD <br />REASON <br />DINER <br />fPEAlAP4 RE0D <br />PEASW <br />SLATE BUM1DBA SURdURGE <br />TYPEOFCONsT <br />PIAHSAPPROYEDBY <br />DATE <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3f05 <br />PUBLK:WORIIS <br />TOTAL <br />