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�►�PLICATION FOR CONSTRUCTION i�ERMIT <br />CITY OF EVERETT • BUILDING C�IVISION <br />3200 CEDAR STREET • EVERE'IT, WA 98201 • 259-8810 <br />O DEMOLQTION ❑ COMBINATI N ��UILDI G��❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTAQDRESS: �2GS��V 117� <br />�n��s t1i11,s . �'ozr���PG �_ �V�.�:-7 `?k�8 355-'rS�'� <br />OWHER uu� uuu�c�s n�... .... _.._.._ <br />CJ <br />LOT <br />lu:il:1 <br />FOOiAGE INVOWED <br />ov vaoreqn �sNoww ee�ow <br />_ BL(1CN OF_ <br />CONSTRUCTION LWW LENDER, ADDRESS. TELEP110NE NUMBER <br />PLUMBIN6 <br />NO. TYPE OF FlXTURE OR ITEM FEE <br />WATER CLUSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY 7RAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTERS <br />.�C I SINK (SERVICE — BAfL ETC.I <br />PERMIT 5 <br />FOR OFFICE USE ONLY: <br />FRONT SEIBACN RE�R SET&1CK SIDE SETBACN <br />USE ZONE <br />HEIGMT LIMITATION <br />Z17 <br />LICENSE � <br />ZIP pHONE STATE LICENSE � <br />HEATING SYSTEM: ❑ GAS � ELECTRIC ❑ <br />GONUGT PERSON NIO PHONE NO. <br />'\..Jr�,s H�'ll��. 355-7�f�f <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLlr,qTION 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 S?ECIFIEO HEREIN OR <br />NOT. THF GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PAOVISION 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 PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAC70RS LAW 1827 RCW AND 296200 WAC. <br />✓���' G-� y �� <br />SIGNA U�� D�TE <br />CITY BUSINESS LICENSE NO. <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />sir. _ enaurn r. � iurrc � <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />MEfAL FIREPLACE ( <br />FIREPLACE INSeRT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />D(HAUST FAN <br />IOTARE� VACANTSITE FELS <br />❑YES ❑ �'7� BIIILDING <br />NO.OFDWELUN6 SIZEOFBLOG?.1 <br />UNIfS PLUMOING <br />OLCUP�NfLO�D B�SEMENT MECIIRNICnL <br />❑YES O NO <br />REASON AO�I110NAL PUN CNF.CK <br />0111ER <br />REAiON <br />STAIE OUIl01N6 SURCH�RGE <br />PLANSAPPROVEDBY CITY OF EVERETT 1`11911C WORNS <br />LOCAL SALES <br />OATF TAX CODE IS 3105 7oTAl <br />PERMIT E <br />TOTAL FEE S <br />FEF �/ // I AECEIPi NO. <br />