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APPLICATIO� FOR CONSTRUC? .JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />J � <br />fl DEMOLITION s7e(l/ COMBINATION BUILDING �� MECHANICAL f� PLUMBING I� SIGN <br />PROJECTADDRESS �)�/)O �`�� �' � �� <br />I i rM"s <br />i1l�_ MA I HEATING SYSTEM: fl GAS rl ELECTRIC ❑ <br />�J� � <br />PRO � ILDI�� <br />�� / �� <br />LE6A DESC�� PRO RTY �5110WN BELOW q <br />LOT� BLOCN OF � <br />zs•oao.o� .00� <br />P�(�;�� �� � <br />CONSTRUCTON IO�N_LE�j�F.R. A�DRE55. TELEPHONE <br />PLUMBIN6 <br />NO. TVPE OF flXTURE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKIN6 FOUNTAIN <br />FIOOR DRAIN <br />BACKFLOW PREVENTER: <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE $ <br />FEE <br />FOR OFFICE USE ONLY: <br />FRONTSETB�CN REAIi5ET8RCN SIDE SETBACK <br />USEZONE <br />NEIGHT UMITATION <br />OCCUPANCY NO Of STOi <br />GR�� n <br />�(/ <br />FIRE �UFM REO'D <br />Y�y <br />FIRE SPRINKLER REOD <br />Y� <br />TYPE OF CONSi. <br />�L N <br />LO7APEA <br />NO OF OWELLIAG <br />UNI75 <br />DATE <br />V�CANT SITE <br />IlYES fl NO <br />SIZE OF BLOG/Tl. <br />I HEREBV 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 GOVERNINCi THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIE � HEREIN Ofl <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW RE6ULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTFUCTION. 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 />CONTRACTORS LAW 1827 RCW AND 28 200 WAC. <br />� �2 -/�'l- 1�/ <br />X <br />51 N�TURE O�TE <br />CITV BUSINESS LICENSE N0. <br />NO. TVPE OF Fl%TUHE OR ITEM FEE <br />A/C —AMNDLG UNITS — H.P. <br />TFORCED AIR SYSTEMS — B.T.U. M E.A. I <br />HEAT PUMP <br />UNIT HEATEPS — B.T.U. M <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE ( <br />FIREPL.4CE INSERT <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />PIAN��/ �( H I �/ /� I F�I/�� .}= I RECEIP; <br />BUILOING I I�i.L/Y)6 I / /A /_ � - <br />,7/1 /�/� J'/ PLUMOING <br />L� +VV ( <br />BASEMEN7 MLGIIANICPL <br />�I f.1YE5 �dNO - <br />AODIPON�L PLAN CNECK <br />' OTHER <br />,� STA'� [ BUILDING SURCHMGE <br />1eV CITY OF EVERETT PUOL17 WORK° <br />LOCAL SALES — <br />TAX CODE IS 3105 TO7AL <br />