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APPLICATItiN FOR CONST�4lC1 �ON PERMIT <br />CIl'Y OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />❑ DEMOLITION Cl COMBINATION f� BUILDING i l MECHANICAL PLUMBING fl SIGN <br />?ROJECT ADDRESS ,.� .� ap r{ A2DS� 2� - <br />�v �e.�� <br />OWNER vEV��P��. MAILADDRESS CITY IIP PNONE <br />y�.��Q �. a�r�n� �ath ��� sv��ti ��s s�a .�c� g�s�a� �kyl -`6oqa <br />IEN�NT MMIAf)ORFSS CITV 21P PI/ONE <br />��.Q1 �AV) <br />ARCNITFCTOROESIGNER MAILADURESS Cltt IIP PHONE <br />GENERAlCON7AACTOR MAILADORE55 CIIV ZIP PHONL STATEUCENSE• <br />FavsH� t t�3soc. P.o. 60� 3�co� 3Ew.E� u�, w a 95'so o w 1�c� -�000 <br />MECHANIC0.LCONTAACiOR M�ILAODRESS CITY ZIP PIIONE SiAiEUCENSE� <br />PLUMBING CONTR�CTOR MAIL ADDRE55 CI1V ZIP PIIONE STATE LILENSE � <br />� <br />UESCRIBE WORK AND SWARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDIN6 <br />BELOW OR ATfAGN TN'O COPIES) <br />LOT BLOCK <br />CONSTRUCiION LOAN LENDER,11WiiE55. TELEPNONE NVMBER <br />PLUMBIIW <br />NO. TYPE OF FlXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />IAVATORY (WASH BASIN) <br />SHUWER <br />�KK6HE�FSINKdr81F,P <br />DISHWASHER <br />LAUNDRY TR<.Y <br />CLOTHES WASHER <br />� URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />-S�NK (STERVICE — BAR, <br />1 �wI AZ 22 '� i <br />/ <br />SUB TOTAL $ � <br />PERMIT S � <br />TOTALFEE $ <br />FOH OFFICE USE ONLY: <br />FRONT SETB�CK REAR SETBACK SIDE SETBACN <br />USE20NE <br />HEIGHT IIMITATION <br />OCCUPANCV NO.0 <br />GROUP <br />FIRE AURM REO'D <br />FIRE SPRINKLER RI <br />IOTAREA <br />NO OF OWELLIN6 <br />UNIiS <br />LOAU <br />VACANi $ITE <br />IlVES fl NO <br />SIZE OF BLOGRI. <br />9ASEh1ENi <br />❑YES fl NO <br />�� �({Qf�.b <br />MEATING SYSTEM: f� GAS f-1 ELECTRIC ❑ <br />CONiACT PERSON �NO PHONE N0. <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 GOV[RNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITV TO VIOLATE 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 TO PERFORM THE WORK FOR NhiICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />x�.n_u-,�.r. � 1 (�1`9Y <br />SIGNATURE D�TE <br />CITY BUSINESS LICENSE NO. <br />TYPE OF FlXTUflE OR ITEM FEE <br />A/C —A/HND!_G UNITS — N.P. <br />FORCED AIR :�YSTEMS — B.T.U. M E.A. <br />UNIT HEATERS — B.T.U. <br />CIOTHES ORYfSRS <br />VENTILATION rAN <br />WATER HEATER <br />WOOD STOVE <br />FIREPLACEINSE <br />GAS PIREPLACE <br />GAS PIPINO <br />EXHAUSTFAN <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE S <br />PLANCNECKNUMB6q _ I FEE � RECEIPTNO. <br />BUILUINC <br />PWMBING <br />MECIIANICAL <br />AD�IIION�I PLAN CHECN <br />OTIIER <br />STATE BUIL�ING SUACIIARGE <br />CITY OF EVEREIT PUBLIC Y.'ORKS <br />LOCAI SALES <br />TAX CODE IS 3105 TOTAL <br />� <br />