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APPLICATI�iV FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOUTION ❑ COMBINATION p'1 BUILDING ❑ MECHANICAL ❑ PLUMBING fl SIGN <br />PROJECT ADDRESS <br />� <br />� � 1(� U-� lyl �n �_ 9 fi � <br />MAILADDRE55 <br />i'�/��. <br />- <br />21P PN <br />ARCNITECTORDESIGNER M�ILADDRE55 CITV 21P PHONE <br />DESCNBE WORN AND SOUAPE FOOTAOE INVOLVEO <br />S�F� _ /s&7 �-Z <br />� 11 �7 � <br />PROPOSED USE OF BUIIDINO <br />�.F. 2 <br />LEG�LDESC IPTONOFPROPERTY�SMOYMBELOWIXiAR H <br />LOT BLOCK OF � <br />PMCEILV! LU. NUAIBER <br />CONSiAUCTI JN LO/�N LENDER, �DORE55. TELEPHONE NUMBER <br />- E,,r. �ir �1c�r✓.�/ �3'/- f/,� <br />PLUMBINO <br />NO. TYPE OF FIXTUF E Olt ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />/ SHOWER <br />LAUN�RYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSEIBACK REAR SETB�CN <br />20 <br />USE20 — � IOTAREA <br />HEKiMTUMITATON NO.OFDWELIING <br />2�0� UNITS <br />OCCVPANCY NpqFSTOPoES OCCUPANTLOAD <br />Z <br />FIFE <br />SIOE SETB =N <br />� <br />VAC�NT SITE <br />CIYES O NO <br />)F BL <br />� � t IViw/G <br />9 S.f. GARAG <br />BASEMENT . � <br />OYES ETNO <br />� HEATING SYSTEM: ❑ GAS O ELECTRIC ❑ <br />- CONTACT�ERSONANDPNONENO. <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <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 SPEC�FIED HEREIN OR <br />NOT. THE GRANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVI5101� OF ANY <br />OTHER STATE OR LOCAL LAW REGULA71N0 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 />CONTRA ORS LAW 1827 RCW AND 296.200 WAC. <br />x �� <br />SIGNATUR D�TE �� <br />CITY BUSINE55 LICENSE NO. <br />NO. � TYPE OF FlXTURE OR ITEM FEE <br />� AIC -AMNDLG UNITS - H.P. <br />/ FORCED AIR SYSTEMS - B.T.U. M E.A. <br />UNITHEATERS-B.T.U. M <br />CLOTHES DRYERS <br />WATER HEATER <br />WOOD STOVE <br />GAS FIREPLACE <br />GAS PIPING <br />EXHAUSTFAN <br />PUICM:CKN�� / <br />� <br />BUIIDING <br />PLUMBIN� <br />MECNANIC�L <br />ADDITIONAL PLAN LHECK <br />OTNER <br />STATE BUIIDING SURCMAAGE <br />PUBLIC WORKS <br />TOTAL <br />SUB TOTAL S <br />PERMIT E <br />TOTALFEE S <br />FEE O i I RECEIPTNO. <br />� <br />