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r. .�. <br />APRLICATIO.� FOR �ONSTRUG��.1N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />❑ DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING fl SIGN <br />PROJECT ADDRESS <br />�� �OtaD <br />cin n� <br />�ENEMLCONTRACTOR� MIJLADDRESS CIIY 21P PHpNE STATEl10EN5E� <br />MAIL�WRESS <br />/ ���� <br />DESCRIBE WOFiK �ND SOU�RE FOOTAGE INVOWEO <br />iot e�oac <br />INS7AUCTION LOAN LENDER, ADDFESS. TEI.EPNONE NUMBER <br />.UMBINO <br />N0. TYPE OF FlXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKINO 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 />FRONTSETBACK REMSETBACK <br />USE ZO�IE <br />HEIOMT UMITATION <br />LOT�PEA <br />NO. OF DVYEWNO <br />UNITS <br />OCCUPANTLO�D <br />RE�SON <br />REASON <br />PUNS APPROVED BY <br />� <br />SIDE SEiB�CK <br />VACANT SITE <br />❑VES ❑ NO <br />SIZE OF BtDO/i.l. <br />ZIP PNONE STATE LICENSE � <br />���Q��p.�o �33 �q,`1- v�uo <br />21P PIp,yE STIITE LISENSE � <br />HEATING SYSTEM: ❑ OAS ❑ ELECTRIC ❑ <br />CONTACT VERSON �HD PMONE Np. <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 GOVERNINd THIS TYPE OF <br />WORK WILL BE COMPL�ED WITH WHETFiER 3PECIFIED HEREIN OR <br />NOT. THE 6RANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REODUTINO CONSTRUCTION OR THE <br />PEqFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THI3 PROPER7Y TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS UW 1827 RCW AND 298.200 WAC. <br />x��.o� ' � S-q S <br />SIONATURE DATE <br />CITV BUSINESS LICENSE NO. <br />MECHANICA�. <br />T1'PE OF FlXTURE OR ITEM FEE <br />A/C — AMNDLO UNITS — H.P. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. <br />VENTILATION FAN <br />RANQEHOOD <br />WOOD STOVE <br />METAL FIREPLACE <br />OAS RANOE <br />BUILUINO <br />PLUTABINO <br />MECHMlICAL <br />SUB TOTAL S <br />NUMBER �/ I FEE I RECEIPT N0. <br />OVES ❑ NO <br />ADMTION�I PUN CHECK <br />OTHER <br />STATE 7UIlAINO SURCNAROE <br />CRY OF EVERETT PUBLIC WORKS <br />LOCALSALES - <br />TAX CODE IS 3105 TOTAL <br />� °:� � <br />, � <br />i. <br />� �` <br />