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APPLICATI� J FOR CONSTi�UC7 JN PERMIT <br />CITY OF EVERETT • BUII.DING UIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOUTION ❑ COMBINATION ❑ BUILDItVG 5d MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS <br />� o �Jr;N aCe 5 a� <br />CITY 21P <br />� . /%. ,, r'` _ ,./> _ , <br />C11' 21P <br />i� <br />PHONE <br />GENERALCONTRAGTOR MAILAOORESS CITV ZIP PIIUNE STATEUCENSE� <br />��I�tIFE AsS. _ <br />MECHANICALCONTFACTOR MAILADDRE55 CITY ZIP PNONE STATEUCENSE� <br />Sq�yAl>c� /��/yN[ti1/3qcc.9�e0tJay Se'n71z.k �'j8/C'L_7S�/-.�i3S �3s�aAe�q7<3 <br />PLUMBINOCONIAICT MAILADOi7E55 CITV ZIP PHONE ST�TEUCENSE� <br />FOOTAGE INVOLVED <br />lEOAL DESCRIPTION OF PitOR <br />LOT��r_ BLOCK <br />�►I CS" C.C_�ll—IAtL'U�/l! `� <br />:ONSTRUCTION LO�N LENDER, �DDRESS. TELEPHONE NIIMBER <br />�LUMBINO <br />NO. TYPE OF FlXTURE OR ITEM FEE <br />WATER CLOSET (TOILEn ' <br />BATHTUB ; <br />UVATORV (YVASH BASIN) —� <br />SHOWER ' <br />KITCHEN SINK 8 DISP � <br />DISHWASHER ' <br />LAUNDRYTRAY { <br />CLOTHES WASHER � <br />URINAL ' <br />DRINKINO FOUNTAIN � <br />FLOOR DRAIN ' <br />BACKFIOW PREVENTERS � <br />SINK (SERVICE — BAR, ETC.) � <br />� <br />SUB TOTAL E ' <br />PERMIT S <br />TOTALFEE 5 <br />FOR OFFICE USE ONLY: <br />FRONT SETB�CK REAR SETB�CN SIDE SETB�CK <br />USE ZONE IOT�REA VACANT SIiE <br />❑VES ❑ NO <br />HEIGHT UMITATION N0. OF DWELlIN6 SIZE OF BLDGR.I. <br />UNITS <br />OCCUPANCV NO.OGSTOPoES OCCUPANTLOAD BASEMENT <br />FiRE <br />❑YE$ ❑ NO <br />;�rvnoveoer CITY OF EVERETT <br />1,M IiI/ Ad- TAX CODE S 3 OS <br />HEATING SYSTEM: `� GAS ❑ ELECTRIC ❑ <br />ONTACT PERSON AND PHONE N0. <br />4 f��ll /�li <!7_i ^ii�CU_ ?/7� <br />I HEREBY 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 GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTIN(i OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW RE�ULATINO CONSTRUCTION OFl THE <br />PERFORMANCE OP CONSTRUCTION. THAT I AM AUTHORRED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS UW 18.27 RCW AND 298.200 WAC. <br />X / �2 /s <br />SIONATUHE DATE <br />CITV BUSINE55 LICENSE NO. <br />NO. I TYPE OF flXTURE OR IT€M �� FEE <br />FORCED AIR <br />UNIT HEATERS — E <br />CIOTHES DRYERS <br />RANQE HOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE ( <br />FIREPLACEINSERT <br />GAS RANGE <br />OAS PIPINp <br />EXHAUSTFAN <br />SUB TOTAL $ ,� ; ' <br />PERMIT S / � ' <br />TOTAL FEE S . �3� ; � <br />PUN CHECK NUMBE6Y) I�E � RECEIPi NO. <br />Bl11LDIN0 <br />PLUMBINO <br />MECH�NICAL <br />ROUITION�L PLAN CHECN <br />OTNER <br />STATE OUILDIN(: F �'^CMARGE <br />rueuc wom.-� <br />TOTA�. <br />