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APPLICAT140 FOR COWSTRUCIPH PERMIT <br />CITY OF EVERETT F BUILDING DIVISION <br />3200 CEDAR STREET I EVERETT, WA 98201 •257-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL fl PLUMRIINn n %Unu <br />CO HNACl PRICE OF WIXiK <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />RCs PmE WWI sWAREr Ac[WVOI O <br />cIA PE o RlI Np. <br />PROPOSED USE W BUILDING <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 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 CONSTRUCTION, THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTMRS1S2T CW D 2962DO WAG. <br />X <br />LEnALMKRNIIXN Or PROPERTY IS��B�ONM BELow l TW7 OC IES <br />LOT If t,ttf BLOCK -SIN W Ji <br />PAPOCLTAI IO NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. IE1EIHENTHY.01R <br />SKINU GIAXE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A'C — A Hi;)LG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />MEAT PUMP <br />�— <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINKd DISP <br />CLOTHES DRYERS <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL <br />S <br />SUBTOTAL $ <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CNECI NUMBER <br />FFE <br />RECEIPT NO <br />USE ZONE <br />WrMEA <br />VACAMTSIIE <br />OYES ❑ NO <br />FEES <br />I VALUATN9N <br />FEE <br />BUM1dND <br />NE*.t IIMIrAf10N <br />fq Ci pNELLINp <br />umrs <br />SQEOFBLODRI. <br />n uu91NG <br />occLmAINcr <br />AAC <br />NO manes <br />accuPANr IaAD <br />eAstusxT <br />DYES D NO <br />MECHANICAL <br />FIRE SPRINKLER REOO <br />REASON <br />ADDITIONµ P1ANCHECK <br />OTHER <br />FIRE ALARM PLOD <br />REASON <br />STATE BUILDING SURCHARGE <br />TYPE OF CCNST 17,PPRDVE <br />l <br />—ECITYOFEVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLICWORKS <br />TOTAL <br />