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APPLICATI� N FOR CONSTRUC'.:ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />CEDAR STREET • EVERETT, WA 98205 • 259-8810 <br />��OMBINATION fl BUILDING I-1 MECHANI�AL ❑ PLUMBING ❑ SIGN <br />PROJECT AQp)io39 ' <br />(o009wM����ni_IA RVt . <br />OWNER MAILAD�RESS CITY 21P PNONE <br />���s Dutil..qP sr� �� srS� �,�o,�os 9eo2� 7Y3 -y7by <br />TENr1NT MnILA0DRE55 CITY 21P PHONE <br />ARCHRECT OF �ESIGNER MAILAO�tiE55 CITY 21P PHONE <br />GENERRLWNTRnLTOft MAILAODRESS Clir ZIP PHONE STATELICENSEM <br />OW NCyL <br />MECNANICA�CONTRACTOFI MAILADDRESS CITV IIP PNONE STATEIJCENSE� <br />PIUMBING CONTRACTOR MAILAODRESS CITV ZIP PHONE STATE UCENSE � <br />LEGAL <br />loT _ <br />BLOCK <br />INVOLVED <br />� <br />.�� C��� 2BOy- �f 0/6 -C.�t77 <br />GONSTRUC=ON LOFN LENOER. AD�PE55, TELEPHONE NUMOER <br />TVPE OF FI%TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />SINK 8 DISP <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, El <br />TWO COPIES� <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSET�ACK REARSETBACI: SIDESET�ACK <br />USE ZONE <br />NEIGNT LIMITATION <br />OCCUPANCY NOOFS70FIE5 <br />GFOUf <br />FIR�M flE0'0 <br />�� � <br />FIRE SPRINKL[R REO'D <br />O <br />TYPEOF N5T <br />IOTAPEA <br />NO.OFDWELLJNG <br />UNITS <br />FEE <br />VACANT 9TE <br />❑YES ❑ NO <br />512E OF BLOGR.6 <br />❑YES fKJO <br />HEAYING SYSTEM: ❑ GAS �ELECTRIC ❑� <br />YHUNt NU. <br />�uN(.9P 743-47�� <br />I HEREBY CERTIFY THAT I HAVE P.EAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAPAE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING TH!S TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIF�ED HEREIN OR <br />NOT. THE GRANTING OF P PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCcL 7HE PROViSION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATI�G 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 />CON� 182 D 296. 0 WAC. <br />Y <br />ATURE DATE <br />CIN BUSINE55 LICENSE NO. <br />MECNANICAL <br />NO. TYPE OF FIXTURE <br />nm. — enatini r. i itiirc — i <br />AIRSYSTEMS—B.T.U. M E.A. <br />HEAT PUMP <br />UNITHEATERS—B.T.U. M <br />CLOTHES DRYEFS <br />VENTILATION FAN <br />RANGEHOOD <br />METAL FIREPLACE I <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPINu <br />9111LDING <br />PLUMBING <br />MECNRNICAL <br />AD�ITIONAL PLAN CHECK <br />OTHER <br />STATE BWI.DIh"� SURCHARGE <br />CITY O!° EVERETT PUBLIC WONKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUBTOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />/• <br />