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AP�LICATII,�I FOR CONSTRUCti ,ON PERMIT <br />CITY OF EVERETT • DUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />f 1 DEMOLITION f 1 COMBINATION f I BUILDING fl MECHANICAL fl PLUMBING fl SIGN <br />PROJECT ADDRESS _ , <br />MAIL <br />O{i <br />AODRE55 <br />21P <br />PLUMBINGCONiRRCTOR MAILADORESS ��n. <br />Z�P PHONE STAiE UCENSE � <br />DESCRIBE WbRK AND SOUARE <br />Aaa �s e�t. c5acncs� $ �z x j� ,u��,n„ < <br />�%�..�r�,ti Ex,����w GA4.�c�- ��i C�u�� <br />PROPOSED USE OF BUILDING <br />iL3,� �c�r.ro � �c:'�L P a.0 rtcoF (,a <br />LEOALDESCRIPTIONOFPROPE TV SNOWNBELOWORATTACHTWOCOP <br />LOT _ Z � s V p�K �4 F �O pF �A/�lis �.1 <br />y' ��ilZoyo��1S w Vtx,���� lU P� Z3 <br />PAPCELTAX I.D. NUMBER <br />`J07'-1 0050 Ci7(e �J <br />CONSTRUCTIONLOANIENDER,ADDRE55.TElEPHONENUMBER <br />NO. TVPE OF FlXT <br />7— WA?ER CLOSET (TOIL <br />1 BATHTUB <br />Z LAVATORY (WASH BA: <br />I SHOWER <br />� KITCHEN SINK 8 DISP <br />GLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FIOOR DRAIN <br />SINK (SEFIVICE — BAR, <br />OR ITEM <br />SUB TOTAL S <br />PERMIT 5 <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK f REAR SETBACK <br />USEZO� / IOTARE� / <br />HEIGHTLIMITATION NO.OFDWEILING <br />ZS / UNITS <br />DGCUPANCV NO.OFSi0RIE5 OCCUPANiLOAD <br />� -i� � <br />_ DA7E 3 <br />HEATING SYSTEM: DS1 GAS f� ELECTRIC ❑ <br />CONTACT PERSON pND PlIONE N0. i <br />� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />�) t{"e PROV S ONS OF AWS AND ORDINAN ES GOVERNMG TH SRTY E OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTIIORITY 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 AUTHORIZEO BY THE <br />OWNEq OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTO/R�S LAW 1827 RCW AND 296200 W�C. <br />x . 1 � vQ�l151��� !� _ � 1� <br />SIGNATURE ORTE <br />CITY BUSINE55 UCENSE NO. <br />FEE NO. TYPE OF F <br />� A/C —A/HNDLG UI <br />; �� FORCED AIR SYST <br />� HEAT PUMP <br />' UNIT HEATERS — I <br />i � CLOTHES DRYERS <br />' 3 VENTILATION FAN <br />; RANGEHOOD <br />� � WATER HEATER <br />' WOODSTOVE <br />� METAL FIREPLACE <br />� FIREPLACE INSER' <br />� f/S GAS FIREPLACE <br />SIDE SETCO�,K� <br />VRCANT 5 E <br />nves n No <br />GAS PIPING <br />EXHAUSTFAN <br />PIAN CNECK NUMBER <br />auuoir+c <br />7���� R�� t PLUMpING <br />-aa A <br />IASEMENT � � MECMRNICAL <br />❑YES IYNO <br />ADDI710NAL PLAN CHECK <br />OTIIER <br />STAiE �UILDING SURCHRRGE <br />CITY OF EVERETT PuoucwonKs <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />RE OR ITEM <br />— H.P. <br />— B.T.U. M E.A. <br />M <br />FEE <br />SUB TOTAL $ � <br />PERMIT $ � <br />TOTALFEE $ � <br />FEE RECEIPT NO. <br />� U // �.3 <br />VALUATION FE <br />/_� .--.-� i /.�! � <br />