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APPLICATII�I FOR CONSTRUC�OPt PERMIT <br />CITY OF EVERETT • BUILDING DiVISION <br />3200 CEDAR STREET • EVEAETT, VYA 98201 • 259-8810 <br />❑ DEMC_ITION ❑ COMBINATION ❑ BUILDING ❑ 61ECHANICAL ❑ PLUMBING Cl SIGN <br />PROJECT ADDRESS �, A„ �f p , <br />ADDRE55 CI'Y ZIP PNONE <br />._..__. .�...�........��o ..�i� ur rnurvt <br />ARCHITECTORUESIGNER MAILA�ORE55 CITY pIP PHONE <br />GENERALCONTpACTOR MAILADDRE55 CITY pIP PNONE STRTELICENSE/ <br />MECHANICAI WNTRACTOR MAILADDFE55 CITY ZIP PHONE STATE LICENSE N <br />PLUIdBINGCONTRACTOR MPILADDRE55 GITV Z�p PHONE STAiELICENSE/ <br />DESCRIBE WORK AN� S�UARE FOOTAGE INVOLVECI <br />PROPOSED USE OF <br />LOT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTAC� PERSON AND PHONE NJ. <br />/ // I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />�.oirvc �— 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 />'PFOP@RTY(SHOWNfiELOYlORATfACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />BLOCK oF 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 />O'NNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />R CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />� /,� ! �,L � ,� - - <br />CONSTAUCJONLOANLEN�Eq,AO�RESS.TELEPHONENUM�ER <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />SINK 8 DISP <br />LAUNDRY'(flAY <br />CLOTHFS WASF <br />URINAL <br />PREVENTERS <br />CF—FAR FT <br />FOR OFFICE USE ONLY: <br />FAONTSETEtACK REARSETBACN <br />USE20NE <br />HEIGHT LIMITATION <br />FIRE <br />FEE <br />dTV BUSINE55 UCENSE N0. <br />NO. TYPE OF FIl(TURE OR ITEM <br />A/C —A/HNDLG UNITS — H.P. <br />FORCEP AIR SYSTEMS — B.T.U. I <br />qANGEHOOD <br />WtiTER HEIITER <br />WOOD�TOVE <br />GAS RANGe <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL S <br />TOTAL FEE 5 <br />SIOE SETBACK � PLAN <br />LOTAREA VACAK}'SITE FEES <br />IIYES fl NO <br />BUILOMG <br />NU.OF OWELLING SIZE OF BLOGII'.I. <br />UNITS <br />PWMOING <br />OCCUPFNTLOAD BASEMENT MECNANICAL <br />f7YE5 fl NO <br />REASON — AODITIONFLPLANCHECK <br />OTNLR <br />FEA�ON — <br />� �SrATEBUIL�INGSURCMARGE <br />PLl�NSAPPFOVEDOY CITYOFEVERFP.' � ��+u:wonKs <br />LOCALSALES <br />pAtt TAX CODE IS 3105 ��rJTAL _ <br />DATE <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE S <br />—i— <br />FEC- I RECEIPT NO. <br />� <br />