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APPLICATI4N FOR CONSTRUCi .ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />�DEMOLITION fl COMBINATION �l BUILDING ❑ MECHANICAL f l PLUMBING fl SIGN <br />PROJECT ADDRESS �1 <br />— ,��. � �..,� � i � <br />OWNER /1 MAILADDRFc�I CITY <br />l I0. N��� .�.1— �V�G� S I i'VIC�� <br />TENANT MAILADDRESS CIiY <br />✓✓ D n� �- <br />ARCMIT[CT OR DESIGNER ' MAIL q��RE55 qry <br />9�o y.� <br />zir <br />PIIONG STATE LICENSE • <br />- --' ��� rnurvt STREUCENSE� <br />PLUMBING CONTRACTOR MAIL ADDRESS CITV 21p PHONE $TATE UCENSE M <br />.............. �..,.,�..� „�.�' S,O o . a <br />DESCRIBE WORK AND SOUAqE FOOiAGE INVOLVED <br />LEG�LOESCRIPTION OF PROPI <br />LOT � BLOCK <br />TA%I.O.NUMBER <br />CONSTRUCTION LOAN LENOER, <br />2 <br />BEIOW OR <br />O�� O o o I <br />TELEPHONENUMBEq <br />NO. TYPE OF FlXTURE OR <br />WATER CLOSET (TOII ET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK $ DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN / <br />FOR OFFICE USE ONLY: <br />FRONiSETBACN REARSETBACK <br />USE ZONE <br />HEIGMT �IMITATION <br />OCCUPANCY NO( <br />GROUP <br />FIRE AIARM REO'D <br />FIRE SPRINKLER RF <br />SUB TOTAL <br />FEE <br />E <br />HEATING SYSTEM: ❑ GAS CI ELECTRIC ❑ <br />CON7�Cr pERSON AND PIIONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND ExAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORiiECT. ALL <br />PROVISIONS OF �AWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIPIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO Gl�:c <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION OR iHE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY iHE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK POR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT� RS 1 qyy iB27 RCW AND 296200� <br />� � / <br />x 1- �( tc o2 q— <br />SIGNATURE DATE <br />CITV BUSINESS LICEhSE NO. <br />FEE NO. TYPE OF FIXTURE OR ITEM FEE <br />� A/C —AMNDLG UNITS — H.P. <br />; FORCED AIR SYSTEMS — B.T.U. M E.A. <br />� HEAT PUMP � <br />' UNIT HEATERS — B.7.U. M <br />� CLOTHES DRYERS <br />� VENTILATION FAN <br />' RANGEHOOD <br />� WATER HEATER <br />' WOOD STOVE <br />� METAL FIREPLACE (WO D BURNING) <br />� FIREPLACE INSERT 000 BURNING) <br />� GAS FIREPLACE <br />� GAS RANGE <br />; GAS PIPIN <br />SIOE SEiBACK I �LAN <br />LUTAREA VACANi51TE FEES <br />IlYES fl NO <br />OUILOING <br />N0. OF �WELLING 512E OF BL�GRI. <br />UHITS <br />PWAI�ING <br />OCCUPANTLOAD BASEMENT MECHANICRL <br />❑VES Il NO <br />REASON /DOIPONALPLANCHECK <br />OTHER <br />REASON <br />STN[ BWL�ING SURCMAqGE <br />PlANSAPPROVEO BV CITY OF EVERETT �UOLIC WOPNS <br />LOCALSALES <br />ont� TAX CODE IS 3105 TOTAL <br />SUB TOTAL 5 � <br />PERMIT S i <br />TOTAL FEE S � <br />F[E I RECEIPTNO. <br />