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^ � <br />APRLICATION FOR CONSTRUCTION PERMIT <br />CITY �F EVERETT • BUILDING DIVISIOIJ <br />3200 CEDAR Sl'REET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOUTION Cl COMBINATION ❑ BUILDINfi ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS <br />� � ao �aQ���� �oA� <br />014NER MI1IL�DOf1ESS ��N Z�P n��. <br />TENAM <br />ZIP <br />� ' <br />GENERALCONTPACTOR MIVI/�WRESS CITY ZIP PHONE SiQELICENSE'� <br />LOT <br />$GUARE FOOTAOE INVOWED <br />etoac <br />LOIW LENDER. IIWRESS. TELEPIIONE MIMBER <br />NO. TYPE OF FlI(TI <br />WATER CIOSET (TOILI <br />BATHTUB <br />LAVATORY(WASH BAE <br />SHOWER <br />KITCHEN SIhK 6 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKINO FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENT <br />SINK (SERVICE — BAI <br />FOR OFFICE USE ONLY: <br />FRONT SE1H11CK AEAR SETB�CK <br />USE ZONE <br />NEIOHT UMITATION <br />HEATING SYSTEM: ❑ (iAS ❑ ELECTRIC ❑ <br />CONTACT PERSON ANO PNO��E N0. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES OOVERNINO THIS TYPE OF <br />WORK WILL BE CAMPLIED WITH WHETHEH SPECIFIED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOUTE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REOULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY t0 PERFORM 1ME WORK FOR NMICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 78R7 RCW AND 298200 WAC. <br />�, �. �_ � � � -9 s <br />x DATE <br />SION�TURE <br />CITY BUSINESS LICENSE N0. <br />ITEM FEE NO. TYPE OF Fl%TURE OR �TEM <br />� /UC—AMNDLOUNITS—H.P. <br />; FOPCED AIR SYSTEMS — B.T.U. M E.A. <br />� HEAT PUMP <br />! UNIT HEATERS — B.T.U. M <br />SUB TOTAL <br />E� <br />SIOE SETBACK <br />VENTILATION FAN <br />RANOEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACI <br />FIREPIACEINSEF <br />GAS FIREPIACE <br />�AS RANOE <br />GAS PIPINO <br />SUB TOTAL <br />TOTAL <br />S <br />PUNCNECKNUMBER I FEE I RECEIPTNO. <br />LOT�REA VAC�NTSITE <br />❑YES ❑ NO Bl11LDING <br />NO.OfDWELL1Na SIZEOFBLDCi/il. <br />UNITS pLUMBINO <br />OCCUPANTLOAD BASEMENT MECMANICAL <br />❑YES ❑ NO <br />�DOITIONAL PIAN CNECK <br />flEASON <br />OTNER <br />HEASON <br />STATE BUILDINQ SURCHAROE <br />PUNS APPROVED BY CITY OF EVERETT PUBUC WORKS <br />LOCAL SALES <br />_.__ TAX CODE IS 3105 TOTAL <br />• � <br />