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,�. ,-. <br />APPLICATIOrI FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-BB10 <br />❑ DEMOUTION ❑ COMBINATION �.BUILDING Gl�iiIECHANICAL L�1'LUMBINR fl SIGN <br />DE9CRIlE Mq11K I1ND SOUARE FOOTIIOE INVOLVED <br />�o�l cexwrnori oF ri+oA <br />�or �� e�otac <br />CONBIiNql10N lOM! LENOEN.I�Dq1E5S. TELEPNOHE MIMBER <br />N0. T <br />`s WATER C <br />� BATHTUB <br />LAVATOR' <br />SHOWER <br />'j KRCHEN <br />DISHWAS <br />` IAUNDRV <br />� CLOTHE: <br />'i URINAL <br />$ DRINKINf <br />� Qa FLOOR D <br />BACKFLC <br />G SINK (SEI <br />i <br />i <br />SUBTOTAL E <br />PeRMIT S <br />TOTAIFEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK ' REM SELBIICN � <br />Aw �� <br />!� <br />USE 20NE�—� LOT �. � �S <br />-/� <br />SIDE SETBACK <br />� <br />VAC�NT SITE <br />� <br />cm <br />21P <br />PMONE _ _ <br />CITY ZIP PHONE STQE IIGENSE / <br />� d � <br />TV ZIP PHONE ST�TE LICEN$E � <br />� �J <br />CITY ZIP PNONE ST�TEUCENSE� <br />HEATING SYSTEM: �f GAS ❑ ELECTRIC ❑ _ <br />CONT/¢TPERSONA�PHONENO. _ _ <br />I HEREBY CERTIFY 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 OOVERNINO THIS TYPE OF <br />WORK WILL BE COMPLIED YYITH WHETNER 8PECIflED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROViSION OF ANV <br />OTHER STATE OH LOCAL LAW REOULATINO CONSTRUCTION OR THE <br />PERFOHMANCE OF CONSTRUCTION. THAT I AM AUTHORRED BY TME <br />OWNER OF THIS PROPERTY TC PERFORM THE WORK FOR WHICM <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOR LAW 1B2 CW AND 296200 WAC. <br />x <br />SIQNIITURE 0�7E <br />CI7V BUSINESS LICENSE NO. <br />TYPE OF FlIfTURE OH ITEM FEE <br />A/C —AMNDLO UNITS — H.P. <br />FORCED AIR SYSTEMS — B.tU. M E.A. �� <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANQE HOOD <br />WATER HEATER _ <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNIN6) <br />FIREPLACE INSERT (WOOD BURNIN(3) <br />OAS FIREPLACE <br />OAS RAN6E <br />PtANCIlEC6N7yABER, � �FEE <br />� � euiwtt+a <br />I� •r �I V�4 } PLUMBIN6 <br />ro S G.K�c` <br />BASEAENT MECM�NIGIL <br />❑YES C7 NO <br />�pp1TiONALPLAN CMECK <br />OTHER <br />STA7E BUIlDINO SURCHARGE <br />CITY OF EVERETT 7UBlIC WORKS <br />LOCAL SAIES <br />TAX CODE IS 3705 TOTAI <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />E <br />� <br />/d 4.00 <br />� <br />