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A�PLICATI( � FOR CONSTRUC't""ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />r <br />❑ DEMOUTION Cl COMBINATION BUILDING �� ❑ MECHANICAL Cl PLUMBING C SIGN <br />PROJECT ADDRESS ��/�O �`�� p���' � /t,/� � <br />�. fY� Ir`•+►w 1►1In <br />NO. TYPE OF FU(TURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK d DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKINO FOUNTAIN <br />FLOOR DRAIN <br />BACKFLUW PFEVENTERS <br />CIIJIf fCFRVICF-RAFl FtC.I <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETBACK <br />IISE 20NE <br />HEIOHT UMIT�TION <br />OCCUPANCY NO OFSfONES <br />GROyP� <br />(S <br />FIRE AU�H�M REO'D <br />lr% <br />FIRE SPPINpK�LER REO'0 <br />{ V+' <br />TVPE OF CONST. <br />TII N <br />LOTAHEA <br />SUB TOTAL $ <br />PERM�T S <br />TOTALFEE S <br />SIDE SETBACN <br />NO.Of OWELUNG <br />UNITS <br />�!/�l71UlT <br />REASON <br />�LJll�� <br />VACANT SITE <br />❑YES ❑ NO <br />7F B�LjI:G�R�J. T <br />(/�T/G' 1 •�• <br />BASEMENT <br />17 YES DF NO <br />CITY OF EVEREtt <br />I.00AL SALES <br />TAX CODE IS 3105 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CaRRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTIN�3 OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL iE PHOVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATIN� CONSTRUC710N OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER CF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS L 7827 RC D 296.200 WAC. <br />/� /�- �.� <br />SG iURE D�TE <br />qTY BUSINESS LICENSE NO.' <br />NO. TYPE OF FlI(TURE OR ITEM FEE <br />AIC — AMNDL6 UNITS — H.P. <br />FOPCED AIR SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />I INIT IJFGTFRC - R TI I lJt <br />CLOTHES DRYER: <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE <br />FIREPLACE INSER <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />E%HAUSTFAN <br />SUB TOTAL 8 <br />PERMIT S <br />TOTALFEE S <br />PUNCHECMNUMOER � I FEE ,_"1 RECEIPTNO. <br />flUILDING <br />PLUMBING <br />MECNANICAL <br />ADDI➢ONAL PLAN CHECK <br />OTIIER <br />STATG OUIIUING SURCH�RGE <br />rum.ic wonKs <br />TOTAL <br />� <br />