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OWNER <br />�-, <br />APPLICATIV� FOR CONSTRUCT rON PERMIT -a <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />ITION COMBINATION �l BUILDING I-1 MECHANICAL rl PLUMBING fl SIGN <br />ADDRESS a � S � � . t'✓�'�� IM/'�w W�r, �I7iJ� ?7 . �IT�.�IZL) <br />MAILADDPESS CITY 21P PHONE �f �7"f V <br />MAIL <br />ARCHRECTORDESIGNER V <br />(',op�l Fril�i. p�/ � <br />GENEiiAL CONTMCTOR ,o M <br />[N1�� <br />21P <br />PMONE <br />STATE LICENSE • <br />MLCHANICAL CONTRACTOR '�' MpIL ADDRESS CITY ZIP PIIONE STATE LICF.NSE � <br />PWMBINGCONTRACTOR MAILADDRE55 Cltt ZIP PHONE STATEUCENSE� <br />LOT' <br />FOOTAGE <br />OFPROPEflTY <br />BLOCK — <br />! vvv ii <br />=55. fE�EPHONE NUMBER <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TO�LET) <br />BATHTUB <br />SHOWER <br />KITCHEN SINK & DISP <br />CLOTHES WASHER <br />URINAL <br />FLOOR D9AIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ET <br />�' <br />FEE <br />PERMIT $ <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETPACK REAA SETBRCN <br />USEZONf- LOiAREA <br />L.-1 2 <br />HEIGHTLIMITATION NO.OFOWELLING <br />UNITS <br />FIR hAIiMREO'�� <br />5 <br />FIRE SPRINNI.ER FEO'D <br />�ES�W� i�RE+�i ��� D <br />TYPE OFf,pNST <br />1 �� � <br />V F� . <br />fiEA50N <br />02�r <br />Pl �NS �PPROVE� 3Y <br />�ATE ��I� Z!) <br />SIDE SETBACK <br />HEATIHG SYSTEM: Cl GAS I-1 ELECTRIC f� <br />CONTACT PEf.50N AND PHONE NO. . <br />i•. �lfh�: VM1i� �!/.�/n� �n'%n� i/1 � <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND K�IOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING 7HIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. fHE 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 CCFi.;TRUCTION. THAT I AIA AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAC RS L 1 27 ACW AND 296200 WAC. <br />X 2 <br />SIGNATURE OATE <br />CIN BUSINES UCENSE NO. <br />NO. I TYPE OF EQUIPMENT � FEE <br />A/C — A/HN�LG UNRS — H.P. <br />FORCEDAIRSYSTEMS—B.T.U. M <br />UNIT HEATERS — E <br />CLOTHES DRYERS <br />VENTILATION FAN <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE <br />GAS FIREPLACE <br />GAS RANGE <br />EXHAUST <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE $ <br />PtANC11ECKNOMOF FEE C HECF�PTNO <br />L'/'r'� l �� %/.'"%' � <br />VnCANT SITE FEES <br />(IYES fi NO AUIL�WG <br />S�ZEol4 27 <br />PLUh191NG <br />BASEMENT M[CN4NICAL <br />fIYES I1 NO <br />�DDI110NAL FLFN CHEGN <br />OIIIER <br />srntE son.oiNc sunc�mnce <br />CITY OF EVERETT rura.ir, wonKs <br />LOCAL SALES <br />_ 5 S TAX CODE IS 3105 TO7AL <br />