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APPLICATI� 1 FOR CONSTRUC7�.�N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />C SIGN <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING 4� MECHANICAL ❑ PLUMBING , <br />PROJECT ADDRESS <br />ONTIER <br />�'72 0 �^ aL.e s m--� <br />/ �' L�I,�CITY��CC IZ�/ <br />7 <br />� CIIY ZIP <br />� <br />ARCNI?FCTOROESIGNER MRIUDORE55 � CITY ZIP �nunt <br />GENERALCONTiP.CTOR MAILAUDAE55 CITY ZIP PHONE STATELICENSE� <br />FoUsri�� Ass <br />MECH�NIG1LCCdlTRACTOR MAILAUDRESS CITY ZIP PHONE STQEUCENSE/ <br />pES�RIBE WOM( �ND SOUARE FIpTAGE INVOLVED <br />S <br />LEOAL OESCRIPTiON OF PROPEHTI' (SHOWN BELOW OR <br />�pT�BIOCK O� <br />.TT� <br />��'(i�.c/G- ��i : v <br />'ION LOAN LEIIDER. �ODHE53. TEIEPHONE NUMBER <br />PLUMBINO <br />NO. TYPE OF flXTURE OR ITEM FEE <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK d DISP <br />DISHWASHER <br />LAUNORY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONT SE7BACN REAR SETB�CN SIDE SETBACK <br />USE20NE <br />HEICNT LIMITATION <br />ZIP <br />HEATING SYSTEM: <br />�ONTRCT PERSOM �NO PYONE <br />GAS ❑ ELECTRIC O <br />I HEREBY CERTIPY THAT I HAVE FEAD AND EXAMINED THIS <br />A!'PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PF�V!SIONS OF LAWS AND ORDINANCES GOVERNIN6 THIS TYPF OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO �IVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTIiER STATE OR LOCAL LAW REdULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WNiCH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 7827 RCW AND 286200 WAC. <br />/ �'L /s <br />$qNATURE DATE <br />CITY BUSINESS IICEVSE N0. <br />NO. I TVPE OF flXTURE OR <br />FORCED AIR SYSTEMS — B. <br />HEATPUMP ��/Z c � j'� <br />UNITHEATERS—B.T.U. M <br />CLOTHES DRYERS <br />.•. <br />WOOD STOVE <br />METAL FIREPLACE ( <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />OAS RANOE <br />SUB TOTAL 8 � i " <br />PERMIT S / � ' <br />TCTAL FEE S ��. ;_ � <br />PUNCH¢CKNUfABE� FEE IAEGEIPTNO. <br />LOT�REA VACANTSITE r��`� <br />❑YES ❑ NO BpIL01N0 <br />NO.OFDWELLING 512EOFflLDNf.I. <br />VNITS PLVM61N0 <br />OCCVPANTLOPD BASEMENT MECMANICAL <br />❑YES CI NO <br />ADOITIONAL PLAN CIIECN <br />REASON . — <br />OTNER <br />PEASON <br />ST�TF OUIl01H(3 .",' iRCNAfiGE <br />PUNSAPPROVEOBY GRy pp EVEHETT PUtltIC WOR�` <br />� I� LOCAL SALES <br />.,..� i� �lI %4Q' TAX CODE IS 3705 TOTAL _ <br />• <br />