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APPLICATIa�N FOR CONSTRUC � ION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION ,� <br />3200 CEDAR STREET • EVERETT, WA 98201 •(425) 257-8810 <br />j� DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAI. ❑ PLUMBING ❑ SIGN <br />� ` ► )- (� 2r�-N➢ C,�, � oP�c, � c. �ue) csr�oE ta�e,,.� <br />�PROJECTADDRESS: ��� �.+ �/� � c�� `�� Z54,�5 io � <br />/ 1 f__l n.il.. �_l�. � M1Lnn7� �i.,.� w A..nn O..11)i <br />.�A MRR�QORESS ' �n. ... ..._� /� � <br />. � _i-.:�sr�o� n� C.�l. �FIIVI(l�- IXI'E1'Q1( <br />:ONTMCT ORICE OF WOAK <br />DESCPI�ND U�R�OOTAG�Y�'nnO �'�R <br />L Y�1 <br />S1VE�r S�t J�U l..�J � 71?t1 L.� <br />LQy���. '0(aS'E�MEFv�,r� v <br />P(iOPOSED USE OF BUIIDIN`G^^ � ��� <br />� �� 1� <br />�WLDESCR TIOP:OFPROPENTI'ISHOWI+BELOWORARAGHM'OCOPiE51 <br />�pT BLGCK _ OF <br />���:�a -e��-o�o � <br />wwce� ux i o nuMaen <br />CONSTRIK ON LWN LENOER. �00�1E55. IEtEPNO4E NUMBER <br />PLUMBIN6 <br />Np, TYPE OF FlXTI'RE OR ITEM FEE <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />IAUNORYTRAV <br />�y. CLOTHES WASHER <br />I URINAL <br />DRINKING FUUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK ISERVICE — BAR. ETC.) <br />FOR OFFICE USE ONLY: <br />fpnHTSFTPA�N AF.AR', <br />USE IONF <br />11EICNf IIMIf/�TION <br />OCCII{'l�NCV NO Ot <br />GRQU� <br />FIPE SPIiMKLER REO' <br />FIRE AIARM PEO'U <br />tvvF or r,o��sr <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE E <br />IOIARE� <br />NO OF UWEIUNG <br />IlNlii <br />IX:CIIP�Ni lOAD <br />f1F�50N <br />PF�SpV <br />r�nr�s �rraovEo ov <br />SiDE SFtB�CK <br />HEAT�NG SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />�'.�Nj�Ci i FRSON ANO PNONE 1� n • n�' � .� ,� <br />I FiEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPcCIFIED HEREIN OH <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCT�ON. THAT I AM AUTHORI2ED BV THE <br />OWNER OF 7HIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APF'LICATION IS MADE AND I COMPIY WITH TNE STATE <br />ZON AC70R5 LAW 18.� CW AND 296200 WAC. �� <br />�� _�___��/ �/97 <br />SIGNATURE D�TE <br />CIT/ &lSINE55 UCENSC NO <br />FORCED AIR 5� <br />HEAT PUMP <br />UNIT HEATEPS <br />CLOTHES DRVf <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLA <br />FIREPLACE IN51 <br />G.1S FIREPLACE <br />GASRANGE <br />SUB TOTAL E <br />PERMIT E <br />TOTALFEE S <br />r'LANOIECNNUMflfN fEF I�Ff.FIPTNO <br />V�CANI SILE <br />❑YE$ ❑ NU fl111101NG <br />SIZE Of BLOGR� <br />{'U)MPWG <br />BASEMENI MFf.r�nNiC<'. <br />❑•ES ❑ �+� <br />nDD�710Nn1. �l �N CMCGK <br />01NEP <br />$I�IC OIILLUINO $IlOC11POGE <br />CRYOFEVERETT runiir.won�s <br />LOCAL SALES <br />TAX CODE IS 3105 TOin� _ <br />FEE <br />