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� <br />APPLICATIt,N FOI; CONSTRUCI.ON PERMI'F <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />f] DEMOLITION f� COMBINATION fl BUILDING f-1 MECHANICAL fl PLUMBING fl SIGN <br />PROJECT ADDRESS <br />33 r 9 �.�.. _ .,( �%in <br />OWNER <br />MAIL <br />arv zm <br />� <br />ARCMITECTORDESIGNER MAILRDURESS <br />7j� �, i ��N Zia PHONE <br />uir <br />CITY Z�p <br />STATE LICENSE / <br />SC/6 orL <br />57ATE LICENSE � <br />PLUMBINCaCONTRqCTOR MAILADDRE55 Cltt <br />Z�P PHOBE SiATE LICENSE r <br />DESCRIBE WORN AND SOURRE FOpTAGE INVO�VED <br />CloS� /.t/ <br />LEGAL CRIP' <br />�oT �9- <br />t�x <br />OFPROPER�TY/�;S/�1O/}yN BE <br />7 BLOCK �_ <br />LENDER.AOURESS.TELEPHONENUMBER <br />TYPE <br />8 <br />CLOTHES <br />FOR OFFICE USE ONLY: <br />FRONT SETBACN REAR SETBACN <br />USEZONE <br />HEIGHT LIMITATION <br />OCCUPANCY NO OF <br />GRO P� Z�) <br />FIRE AUR% REO D <br />� <br />FIRE SPRINKLER REQ <br />No <br />ttPE OF CONST <br />�-nJ, <br />LOTAREA <br />HEATING SYSTEM: C�GAS Cl ELECTRIC ❑ <br />CONTACT PENSON ANU PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORqECT. 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 DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONuTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOAM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTO S LA 1827 RCW AND 2g6.200 WAC. <br />x L����"ti.------ �` -/ �, j.5� <br />SIGNpTURE UATE <br />CITY BUSINESS LICENSE NO. <br />OR ffEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br />' A/C—qMNDLGUNITS—H.P. <br />� FORCED AIR SYSTEMS — B.T.U. M E.A. <br />� HEAT PUMP <br />' UNIT HEATERS — B.T.U. M <br />� CLOTHES DRYERS <br />SUB TOTAL $ <br />PERMIT 5 <br />TOTAL FEE $ <br />SIDE SETBqCK <br />NO OFOWEWNG <br />UNIT$ <br />�co ov <br />�� <br />VRCANT SIiE <br />fl'IES i'1 NO <br />SIZE OF BLDGRI. <br />BASERIENT <br />❑YES fl NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE <br />FIREPLACE INSER' <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />PLAN CHECK <br />OUIL�ING <br />PlUM01NG <br />MCCM�NICAL <br />ADDIPON4L PLpN CNECK <br />OTHER <br />STATE OOILDING SUf1LN�RGE <br />ruouc wonres <br />TOTAL <br />SUB TOTAL $ <br />PERMIT 5 <br />TOTAL FEE $ <br />��1 � <br />�O ✓ � <br />FEE / REC <br />��,2 7s , <br />,) / / % I �(� <br />i <br />� : ,�%.l <br />