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APPLICATIG.� FOR CONSTRUC7.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA ggp01 • 259•8810 <br />C7 DEMOLITION fl COMBINATION fl BUILDING R� MECHANICAL f 1 PLUMBING �l SIGN <br />PROJECT ADDRESS <br />�l �l2 O ,v� �(? S G�� <br />�NMER MAILAODPE55 Cltt 21p pN�yg <br />�/E�C2 (1fvC�c�Fm�Ni �OD� ���%7�✓e �� ��-/ �`i�-6oGTj <br />TENRNT MAILAODRESS <br />CIiY JIP n..n..� <br />nNq1rtEGTORDESIGNER MRIL�DURE55 „ITY ZIP PMONE <br />GENERAICONTPRC70R MAILADDRESS CIT�' 71P PNONE STATEIJCENSE� <br />F12l�fICE Ass. <br />coNTnncron <br />coor�ce invaveo <br />ti <br />OF <br />LOT� BLOCK <br />LENDER, ADDRESS. TELEPHONE NUMBEf1 <br />PLUMBINU <br />NO. TYPE OF Fll(TURE OR <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BAS�N) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNOFYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKINO FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ETC.1 <br />PERMIT $ <br />TOTAL FEE S <br />FOR OFFICe USE ONLY: <br />FRONT SETBACK REAR 5[TBRCK <br />USE20NE LOTAREA <br />NEIGHTLIMITATION NO.OFOWELUNG <br />UNITS <br />FlRE <br />PLANS�PPF <br />'JM <br />onTe 1. <br />ZiP PHONE STATE UCENSE r <br />:0...-. ' _" _'.�� <br />HEATING SYSTEM: �d GAS ❑ ELECTRIC ❑ <br />40NTACT PEFSON AYO PIIONE NO. <br />F�{iUL- �f i��% %i�CL/_ 7/7� <br />i HEREBV CERTIFV THAT I HAVE READ ANO EXAMINED THIS <br />— APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPIIED WIfH WHETHER SPECIFIED HEREIN OR <br />cov�Esl NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />2 AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />� PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV 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 18.27 RCW AND 286.200 WAC. <br />x�NAT�RE l� I2�S/%'i` <br />CITV BUSINE55 UCENSE NO. <br />FEE NO. TVPE OF flXTURE O <br />� ei�_. .�n� nwr H.I <br />; Z FORCED AIR SYSTEMS — B. <br />� Z HEAT PUMP �/Z r ' <br />' UNITHEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />� VENTILATION FAN <br />; RANGE HOOD <br />� WATER HEATER <br />' WOODSTOVE <br />i METAL FIREPLACE (WOOD B <br />� FIqEPLACE INSERT (WOOD I <br />i GAS FIREPLACE <br />� GASRANGE <br />; LY,Yi� GASPIPING <br />SIOE SETB�CN <br />VRC�NT SITE <br />f1VES fl NO <br />PUN <br />BP'LOING <br />SIZE OF BLOG?I <br />PLUMBING <br />BASEMENT MECIIRNICAL <br />❑ VES fl NO <br />ADDIPONRL PLAN CNECK <br />O7MER <br />STAIE BUILD:NG SURCHRRCE <br />CITY OF EVERETT �UBLIC WpqKS <br />LOCALSALES <br />' TAX CODE IS 3105 TOTAL <br />SUB TOTAL S ,�C7 � ' <br />PERMIT S / � � <br />TOTAL FEE S -ri �C ! � <br />FEE I AECEIPTNO. <br />C <br />