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r-. ,^-. <br />APP'LICI�TIvN FOR CONSTRUC .1AN PERMIT <br />CITY OF EVERETT • 6UILDING DIVISION <br />3200 CEDAR STREET,� EV�EFj-E— _TT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION � BUILDIN� G ❑ MECHANICAL p PLUMBING ❑ SIGN <br />a ui t u�tnoe • <br />MECHANICALCONTRACTOR MAllA0DRE55 CITY Z�P PIIONE STATELICENSE� <br />PLUMBINGCONTRACTOR A1AIV.ODRE55 Cltt ZIP PHONE STATEUCENSE� <br />PfiOPOSED USE <br />�oT <br />BLOCN <br />FOOiAGE1NVOtVED <br />�rtACN TWO COPIES) <br />;i. <br />PMCEL TA% I.D. NIIMBER <br />� CONSTRUCTION LOAN LENOER.AODRESS. TELEPHONE NIIMBEH <br />PLUMBING <br />� N0. TYPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />� LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 3 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />����<�_"�� BACNFLOW PREVENTERS <br />'�� SINK (SERVICE—BAR, ETC.) <br />{. <br />SUB TOTAL S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK AEARSF.TBACK SIOE <br />USE ZONE <br />HEIGHT LIMITATION <br />OLCUPANCY NO Oi SIONIES <br />lOT <br />NO OF OwELIING <br />UNIf$ <br />n+iF <br />VAC�NT SITE <br />❑YES ❑ NO <br />SIZE OF BLDGR.1 <br />BASEMENT <br />�YES ❑ NO <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE 15 3105 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACT PERSON �ND PNONE NO. <br />I HEREBY CERTIFY THAT I HAVE FEAD AND EXAAdINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORPECT AlL <br />PROVISIONS OF LAWS AND ORDiNANCES GOVERNING THIS TYFE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEFEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIi':: <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW qEGULATING 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 ANO I COMPLY WITH THE STATE <br />CONTR�S LAW 7827 RCW pND 296200 WAC. <br />X s �D ✓� 7' % V <br />S!GNATUFiE OATE <br />CIN BUSINE$$ IICENS[ NO. <br />NO. I TYPE OF EQUIPMENT � FEF <br />rvv—rvnnvu <br />FORCED AIR S' <br />HEAT PUMP <br />UNIT HEATERS <br />R,4NGE HOOD <br />WATER HFATER <br />WOODSTOVE <br />GASRANGE <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAI. S <br />PERMIT S <br />TOTALFEE S <br />PUN CIIELK NUM9ER � FEF I RECEIPT NO <br />011ILOiNC <br />PLIIMOING _ <br />MECNnuiCAl <br />ADb1110NAL CIAN CIIfCN <br />0111E11 <br />.STA7E OUILO�N6 SIIRCHARGE <br />rum ic wonKs _ <br />TOTAL __ <br />