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APPLICATION FOR CONSTRUCTAN PERMIT <br />m OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. WA 88201 •259-NIO <br />❑ DEMOLITION ❑ COMBINATION ❑ BUU//�I�.00NN�NOO ❑[[M�ECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ACDRESS: '2c3& 4 AOGlB�. �i6 <br />u n mrEw _ r 0" w n nrpyK <br />A YECTOFIM IY .M ss CITY !�r r11gf <br />GENERAL CU1 TOR 4MLA ss CITY 11, MIIQE STATE LM ,,,K <br />CCNTW T f1YLE O[WpW. <br />HEATING SYSTEM: ❑GAS DIELECTRIC ❑ <br />CESCg//BCE W AA. s ARE FOOYgE NYOtAO <br />CONTACT IY"sm. PlldrtNO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AIAT CORRECT ALL <br />PROVISIONS 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 DOGS 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 AUTTHORRED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18 27 RCW AND 296.200 WAC. <br />,��I <br />vFawsfo USE a euxnmo <br />LEauoEsuBRTla a an FM I.^nR)' ULM GRATUICH TMOOFIESI <br />LOT uacK a_ <br />PNCEL TM IA. MAKER <br />Cd13TMIC110111dNLEWER.A00REss. RIERIS{MAZER <br />$RYIATUiE WIE <br />alv p15Y1ESS LCFHEE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />ND. <br />TYPE OF EOIKPEIBIT <br />FEE <br />WATER CLOSET (TOILET) <br />NC—AAiNDLO UNITS <br />T <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />20;,90 <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW "'•.:VENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL f <br />SUB TOTAL S <br />O <br />PERMIT S <br />PERMIT III <br />c�- so v <br />TOTAL FEE S <br />TOTALFEE Sr <br />}Q !Cn <br />FOR OFFICE USE ONLY: <br />[IKWT SETBACII <br />BFw Y10/{R <br />LCf sFIBACR <br />Rw CICQ MN![n <br />5�7 a <br />[EF <br />BFf1VI N0 <br />IIM IONS <br />LOT AREA <br />vAcwt WE <br />OYES ❑ W <br />FEES <br />VALUATION <br />FEE <br />BUIdMt <br />MWIT LIM[ATION <br />NO n[nN4lUNn <br />UM[F <br />SIZE OF BLC6N1 <br />%IrYBM(' <br />a <br />Qw— <br />TO RsI(NES <br />OCCWwTIOnn <br />BASEMENT <br />❑YFS GNG <br />wc.N CN <br />AnplpNAlMwCrKLR <br />RIE SRBNGTR REOV <br />RFASON <br />ONrtN <br />[pENM Awo <br />REAsO <br />STATE BULnMO sr111[I4Rnf <br />Irm IN CONSr <br />rLnNs wRnovfner <br />ouE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAN( CODE IS 7105 <br />nro�IL vgms <br />TOTAL <br />