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APPLICATIO�.+ FOR CONSTRUCTI.�N PERMI'T <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />❑ DEMOLITION I� COMBINATION fl BUILDING yr�MECHANICAL fl PLUMBING I-1 SIGN <br />nr <br />TENANT . \ M�ILADDRE55 CITv ZiP PHONE <br />\� <br />ARCPoTECTORDESIGNER MAILADORE55 Gitt ZIP PHONE <br />GENERALCONTRACTOR M/JLADDRESS CI(V 21P PIIONE SiAiEUCENSE� <br />MECHANICALCONTAACTOR MRILADDRESS CITV ZIP PIIONE STATEUCENSE� <br />t7�ump�c.'(tito<<nnh�r�,l �0 (�nx h�2r Lum .�Y( �t�Li� `17�/f�-I� OLyMPM�I-76o1 <br />Pl IN CONTRACTOR MAILAODRESS I�Y Z�P PIIONE STATELICENSE� <br />LE011L DESCRIPTION OF4ROP1 <br />l0T BLOCN <br />CONSTRUGT�ON LOAN LENUER. AUDfiESS, <br />N0. TYPE OF FIXTURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNDRYTRAY <br />DRINKINO FOUNTI <br />FLOOR ORAIN <br />Bl.CKFLOW PREVI <br />SINK (SERVICE — <br />FOR OFFICE USE ONLY: <br />FRONT SETB�CN REAR SETBACN <br />USE ZONE — <br />NEIGHT LIMITATION <br />OCCUPANCY NOAF <br />GROUP <br />FIRE �URM REO'D <br />FlRE SPRINKI.ER REI <br />LOTAREA <br />OR ATTACH TWO CO�IES) <br />NUMBEH <br />SUB TOTAL t <br />PERMIT $ <br />TOTAIFEE S <br />SIDE SETBACN <br />NO OFOWEUING <br />UNITS <br />DATE <br />0 <br />VRCANT SITE <br />❑YES ❑ NO <br />SIZE OF OLDGRI. <br />OYES ❑ NO <br />CITY OF EVERETT <br />LOCAL SALF.S <br />TAX CODE IS 3105 <br />HEATING SYSTEM: �TGAS ❑ ELECTRIC ❑ <br />COCIIACTPERSONPNOPNONENO. _ _ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE APJD CORRECT. AlL <br />PROVISIONS OF LAWS AND OFiDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHEiHER SPECIFIED HEREIN OR <br />NOT. THE GF;ANTING 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 />CONTRl�TORS LAW 1827 RCW AND 296200 WAC. <br />_1������ <br />SIGNRTUf /[`� /1 DRTE <br />� lJ� r,l �i <br />CIiY BUSINE55 LICENSE NO. <br />NO. I TYPE OF Fll(TURE OR ITEM � FEE <br />A/C — NHNDLG UNITS — H.P. <br />FORCEO AIR SYSTEMS — B.T.U. <br />HEAT PUMP <br />UNITHEATERS—B.T.U. M <br />CLOTHES ORYERS <br />RANGEHOOD <br />WATER HEATER <br />GAS FIREPL <br />GAS RANGE <br />SUB TOTAL <br />S <br />$ <br />RANCHECKNUMBER �fEE IRECEIPTNO. <br />BUILDI4G <br />PLUMDINQ <br />MECHANICAL <br />AODITION�L PLAN CNECN <br />OTHER <br />STPTE BUILDINQ SURCIIARGE <br />PUBLIC WOPRS <br />TOTAL <br />