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APPI.ICATI�..� FOR CONSTRU��7.JN PERIIAIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STAFET • EVERETf, WA 98201 • 253•8810 �+ T� <br />❑ r�`AOUTION y� COM8INATION fl 3U'.IDING f 7 MECHANICAL f] PLUMBING ❑ SIGN <br />prR�;;E'� I' ADDRESS , . _ / / � , �—� � <br />01YN':R <br />C <br />'S: Ai1 <br />J <br />ciTr <br />i^e <br />PHONE <br />��ac <br />PHONE <br />� <br />n i�n���ivrvom m���quuneno GIIY ZIP GHONE � <br />7�/$�'�1E �'S o sG:�CI-- <br />'GFHC^nLGGNiRnCTOii MAILAD'JRE55 CITV ZIP PHONE STATELICEN:.EX <br />wr tir <br />N <br />P�'!.RINGCOYTPACTOp MAILADURESS CIN ZIP PHONE STATEUCENSEx <br />CONTRACT <br />LEGAL <br />LOT _ <br />OF BUILDING <br />NLOCK <br />/ <br />CONSTPUCTION LOAN LEN�ER. ADDRE55. TELEPHONE NUMBER <br />TYPE OF <br />WATER CLOSET� <br />BATHTUB <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />CINK /RFRVIf:F — RAR FT <br />ITEM <br />PERMIT 9 <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN REAR SETBACK <br />%O J� <br />USEZON LOTFREA . <br />,�a2 J�'? <br />IIEIGNTLIMITpTION NO.OFUWELIJNG <br />� UNITS � <br />� <br />FEE <br />SIDE SETBA.K . <br />/ � <br />J <br />VACANT 51T <br />❑ YES C7 NO <br />❑VES f�/NO <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />HEATING SYSTEM: ❑ GAS �l"cLECTRIC ❑ <br />CONTACT PERSONANO PHONE ND. <br />LY�E" E ,8L/�.✓.� .�S H7' <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIUNS 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 REGULtiTING 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 />CONTRAC�S LAW 1827 RCW AND 296.200 WAC. � <br />� � .� `s' � y..,� <br />SIGN DATE <br />CI IISINESS LICENSE ND. <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />A/C — A/HNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M E.A:. <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />METAL FIREPLACE ( <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GASRANGE <br />SUB TOTAL S <br />PERMIT S <br />��/J I FEE �,, I RECI IT� � JQ <br />0 <br />BUILDING 6�i 533 L . ' ; -` <br />i <br />PWMBING � <br />_�_ <br />MECHANICAL 0 � <br />ADDITIONRL PLAN CHECK i <br />i <br />OTHER � � <br />i <br />STATE BUILDING SIIRCHARGE i �� <br />PU6LIC WORKS � <br />2C�; <br />TOTAL �o � n i �/J <br />