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,-. _ <br />APPLICATI� N FOR CONSTRUC'..ON PERMlT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEOAR STREET • EVERETT, WA 98201 • 259•8810 <br />❑ DEMOLITION ❑ COMBINATION�� BUILDING f7 MECHANICAL ❑ PLUMBING fl SIGN <br />PROJECTADDRESS �1��0 �`�� � � �. <br />� rr� <br />OWNER MMLADDRESS CITV ZIP P�pNE <br />J � <br />:tr �,"L�..'....7,' "« � <br />� <br />,('�� � — _L <br />�1�.'� — � � ■ <br />. , .. ,', ... .• . . <br />. : .... <br />TELE%IONE NUMBER <br />NO. I TYPE OF FlXTURE OR ITEM <br />BATHTUB <br />KITCHEN SINK S DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />URINAL <br />BACKROW PREVENTERS <br />SINK (SERVICE — BAR. E1 <br />SUB TOTAL $ <br />PERMIT S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETBACK SIDE <br />USE ZONE <br />HEIONT LIMITATION <br />LOi�REA <br />NO. OF [1WELIJNG <br />UNITS <br />OCCUPANTLOAD <br />� <br />RE�SON �.y�//_ <br />��7///KT <br />REAySO�N�� �/ <br />t/F! �I[�S7 <br />PUNS APPROVED BY <br />O�7E <br />GIiY <br />21P <br />G <br />IIP � PHON 5TAlE IICENSE � <br />21P PHONE S ATE LICENSE 11 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE ;aAME TO BE TRUE AND CORRECT. ALL <br />PROV�SIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED MEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTNER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONT CTORS LA 1827�iC AND 296200 WAC. <br />i� � / /�- 9 y <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO. <br />MEGMNNICAL <br />NO. TYPE OF flXTURE OR <br />A/C — AMN�LG UNITS — H.P. <br />HEAT PUMP <br />UNITHEATERS—B.T.U. M <br />WOOD STOVE <br />GAS FIREPLACE <br />E%HAUSTFAN <br />PLAN CIIECK <br />V�CANI $ITE <br />f1YE5 CI NO BUILOIN6 <br />52E OF BLOGR.I. <br />! 1� � r PlUM91NG <br />! <br />ASEMENT MECNANICRL <br />❑VES �LNO <br />AO�IPONAL PUN LMECK <br />OTHER <br />ST�TE BUIIAINO SUPCHAROE <br />CITY OF EVERE7T PUALIC WORNS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUBTOTAL S <br />PERMIT $ <br />TOTALFEE S <br />FEE R C[IPTNO. <br />VALUATION FI <br />���/lA/ /f <br />� <br />FEE <br />