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APPLICATI�1 F�� �O�NS'�RU�C�N �ERI11lE'T <br />CITY OF EVERETi • BUILDINC DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />f7 DEMOLITION I-1 COMBINATION I-1 BUILDING MHCHANICAL r� pLUMBING rl SIGN <br />PROJECT ADDRESS / � n � <br />, , <br />�?,�,� /�'lt/�: /C0� �_/�c'�_� <br />1, WNE� ��I M( W � R I/��� ' u' _ CITV ZI? t'HON[ <br />OE�CRIBE <br />LOT <br />BLOCK <br />�SHOWN BELOW OR ATfACH TWO COPIES� <br />CONSiRUCTION LOAN LENUER, ADDRE55. TELEPHONE NUTABER <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />�ATHTUB <br />KITCHEN SINK 8 DiSP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />BACKFLOW PREVENTEFS <br />S��dK (SERVICE — BAR. ET <br />PERMIT 5 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FPONT SE7�ACK RE�R SFTUPCN SIOE SETBALN <br />USE ZONE <br />1{EIGMT LIMITATION <br />pCCUPANCY NO C <br />GROUP <br />FIFE AURM REOD <br />LOTAREA <br />NO. OF OWELLING <br />IINIiS <br />PLAN$ <br />DATE /'r/-J � <br />HEATING SYSTENf: f 1 GAS �l ELECTRIC fl <br />CONTACT PERSON AND PHONE N0. . <br />1 HERFBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICFTION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPL�ED WITH WHETHEF SPECIFIED HEREI;J OR <br />NOT. THE GRANTING OF A PEPMIT DOES NUT PRESUME TO GIVE <br />AUTtiORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCT�ON OR THE <br />P'cRFORMANCE OF CONSI'RUCTION. 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 />CONTRA T RS LAW 1827 RCW AN 9620 <br />X �� � <br />SIG ATII DATE <br />CITY SINESSLICENSENO. <br />FEE NO. TYPE OF EOUIPMENT � FEE <br />' A/C—AMNDLGUNITS—H.P. <br />� FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />�—� HEAT PUMP <br />CLOTHES1DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />W OOD STO'v E <br />METAL FI7EPlACE (WOOD P� <br />FIREPLACE INSERT (�VOOD E <br />EXHAUST FAN <br />SUBTOTAL S ,�Co� � <br />PERMIT 3 / i <br />TOTAL FEE 5 �7 r! - <br />PUN CI IECN MUMp[q � FEF I �ECEIPT N0. <br />V/CANi SITE FEES <br />f 1 VE5 f 1 NO ppIL�ING <br />SIZE OF 9LDGR1 <br />PLUMOING <br />9ASEMENT ML'C11nNICAL <br />IlYES il NO <br />Ap01110NAL PL�N CIIf:CN <br />OiH[fi <br />SiNE �IllIDINC SURCHMf,E <br />CITY OF EVERETT ruour, wanres <br />LOCALSALES <br />� ) TAX COOE !S 3745 TOTAL <br />