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APPLICATION FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 . (425) 257-8810 447r <br />❑ DEMOLITION ❑ CCOMBINATION ❑ BUILDING MECHANICAL C PLUMBING ❑ SIGN <br />- <br />PROJECT ADDRESS; l�//1 nn I,-- -, /\ e 1 <br />-"""' MAIL. ADDRESS f,I1Y <br />ARCMITF.Li pR DESIGNER MAII ADDRESS <br />DESCRIBE WORK AND SOU --REF AGE INVOLVED <br />LLUAL ULSCRIPTION OF PROPERTY (SHOWN BELOW OR <br />LOT BLOCK nr <br />PARCEL TAXI NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />PLUMBING <br />• I <br />TYPE OF FIXTURE OR ITEM <br />ATER CLOSET (TOILET) <br />ATHTUB <br />AVATORY (WASH BASIN) <br />HOWER <br />ITCHEN SINK 8 DISP <br />ISHWASHER <br />AUNDRY TRAY <br />LOTHES WASHER <br />RINAL <br />RINKING FOUNTAIN <br />OOR DRAIN <br />ACKFLOW PREVENTERSNK (SERVICE — RAP RTr I <br />1P <br />LIP PIIONF STATF LICENSE F <br />CITY LIP PHONE <br />--STATE LICENSE , <br />HEATING SYSTEM: t-GAS ❑ ELECTRIC ❑ _ <br />CONTACT PFRSON AND PHONF.NO <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 />ACTORS LAW 1B.27 RCW A D 296.200 WAC. <br />X 7- <br />SI RE DAlC <br />CITY BUSINESS UCENSL NO <br />FEE NO. TYPE OF EQUIPMENT FEE <br />AIC—A/HNDLG UNITS—�— <br />FORCED AIR SYSTEMS , <br />HEAT PUMP 1 <br />UNIT HEATERS <br />:E��ll <br />E�EE�� <br />SUB TOTAL <br />PERMIT <br />S <br />S , <br />SUB TOTAL <br />PERMIT <br />$ <br />E <br />FOR OFFICE USE <br />TOTALFEE <br />ONLY: <br />S I <br />TOTAL FEE <br />S <br />FRONT SFTBACK <br />USE LONF <br />PFAR SFTBACK <br />101 AREA <br />SIDE SE iBACK <br />VACANT SITE <br />DYES ❑ NU <br />NU <br />PLAN CRECK NUMPFR <br />:z" `1'�(� <br />FEES <br />FF . <br />C <br />_ VALUATION <br />RFCFIPT NO <br />FF <br />BOIL DING <br />- <br />HEIGH I (IMITATION <br />NO OF DWELLING <br />IINRS <br />511E <br />OF RLCIGRI <br />PI IIMRING <br />MFCHANICAL <br />-"--"----- <br />---- -- -- -- <br />OCCUPANCY NO CI SINI'�LS <br />GROUP <br />OCCUPANT LOAD <br />BASFMENI <br />OrES ❑ NO <br />TIRE SPRINKLERREO'D <br />RPASON <br />— <br />ADDID0NAI.r1ANCNFCK <br />UTRER <br />_ _---- <br />FIRE ALARMREO'D <br />RF AcDV <br />SIAIIBIKI D'NG SURCHARGE <br />TYPE OF PON" <br />PIIII APPROVFDBY <br />CITY OF EVERETT <br />LOCAL SALES <br />ria Ic WORKS <br />-- <br />---- <br />DATE <br />TAX CODE IS :1105 <br />TOTAL <br />