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APPLICATI�1 FOR CONSiRUC7'4�i1� PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 J <br />❑ DEMOLITION ❑ COMBINATIOk CI BUILDING ❑ MECHANICAL I� ALUMBINC Cl SIGN <br />PROJECT ADDRESS ��T �� � <br />22 zZ Lo4��r �o��,.l -A�� <br />OWNER MAILAODRFSC I <br />MAIL <br />OR UESIGNER <br />GENER�LCONTRACTOF MAILAUOfiE55 QTV 21P PpONE STATELICENSEM <br />MECHANICALCONTRACTOR MAILADDRESS CITV ZIP PIIONE STATELICENSEM <br />CONTRACTOR <br />PqOPOSED USE OF BUILOING <br />LEGAL DESCPIPTION OF PROPE <br />ioT e�ocK <br />roornce iNvo�veo <br />BELOW OR ATTACH TlYO COPIES) <br />CONSTRUCTION LOAN LE.1'DER. AODRE55, TELEPHONE NUMBER <br />TYPE OF FIICTURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASINI <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ET <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAR SETBPCH <br />USE20NE <br />HEIGHT LIMITATION <br />SPRINKLER REO'0 <br />PERMIT <br />TOTALFEE <br />S <br />CI1V <br />FEE <br />T <br />Q'2, � <br />i <br />� <br />42 . <br />� <br />� <br />� <br />� T <br />i <br />T <br />� <br />.i �.. <br />UCENSE � <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACT PERSON AND PHONE NO. <br />G7G ^�4�7( <br />I HEREBY CEFiTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORh WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. T�HE 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 CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLi�4TION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTO LAW 1827 RCW AND 296.200 WAC. <br />r �teH ��/� 4S <br />SIGNATI1flE OFTE <br />!%?.�olO �i�J <br />CITY OUSINE55 LICENSE NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C — A/HNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />HEAT[RS — <br />RANGE <br />WATER <br />METAL FIREPLACE ( <br />- FIREPLACE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />� GAS PIPING <br />� <br />4 <br />SIOE SETBACK � PLM! <br />�IOTAREA VACANTSITE FEES <br />❑YES ❑ NO BUILOING <br />NOOFDWELLING SREOPBI.DG/TI. <br />VNITS <br />PLUMOING <br />OCCUPANTLOFD BASEMENi MELHAWCAL <br />❑YES ❑ NO <br />ilEASON ADDITIONAI. PLAN CHECK <br />OTHER <br />REASON <br />STATE 911IL�ING SORCMAflGE <br />PIANSAPPROVEDBY CITYOFEVERETT PUOLICWORKS <br />LOCAL SALES <br />onre TAX CODE IS 3105 TOTAL <br />FEE <br />PERMIT 5 <br />TOTAL FEE S <br />RECEIPT NO. <br />