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APPLICATIG./ FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINAT!ON A'f BUILDING ❑ MECHANICAL fl PLUMBING Cl SIGN <br />PROJECT ADDRESS <br />� `'" .� J V � f✓� �. <br />s citt <br />MAILAODRE55 <br />IIRCMITECTORDE516NER MAILADORE55 CITY IIP PHONE <br />WORN <br />DESCRIBE WORK AND SW�RE FOOT�GI <br />S,F�P, _ - /Bf <br />� /19� <br />LEGAL DESC PTION OF PROPI <br />LOT � BLOCK <br />CONSTRUCTION LO�N LENDEq, AWRESS. TELEPMONE NUMBER <br />NO. � TYPE OF FlXTURE OR lTEM <br />Z WATER CLOSET rtOILETI <br />LAVATORY <br />SHOWER <br />UUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ET <br />FOR OFFICE USE ONLY: <br />FROMSETBACK RE�RSETBACK <br />USE ZO� <br />HEIGNT LIMIiATION <br />OCCVPANCY NO ( <br />GROU <br />• V-� <br />FIRE AUFM PEO'D <br />fIRE SPRINKLER RI <br />TYPE OF CONST. <br />LOTAREA <br />SUB TOTAL E <br />PERMIT $ <br />SIOE SETB�CK <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACTpEP50N AND PMONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION ANO 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 dIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR IOCAL LAW REGULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CONfRA ORS LAW 18.27 RCW AND 296.200 WAC. <br />X � <br />SIGNAiUR �TE <br />CITY BUSINESS LICENSE NO. <br />MECNANICAL <br />FEE NO. TYPE OF Fll(TURE OR ITEM FEE <br />� A/C—AMNDLGUNITS—H.P. � <br />� FORCED AIR SYSTEMS — B.LU. M E.A. � <br />� HEAT PUMP � <br />! UNIT HEATERS — B.T.U. M ! <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />FIREPLACE INSE <br />GAS FIREPLACE <br />SUB TOTAL <br />TOTALFEE S <br />PUNCNECKNUMBER FEE � REGEIPTNO. <br />����� J� l <br />V�C�NT S�TE htCS YwwI111vn <br />f7VE5 ❑ NO BUILDING <br />/07.1 �/7 <br />r�m, ov owewna si oF e� y <br />UNIT$ / � /�; LIVIN�C p�UMBING <br />OCCUPANTLOAD 6 BASEMEFNT � MECMIJlIC�L <br />❑YES [MNO <br />e�.�..., ADDITIONAL PIAN CHECN <br />DATE <br />CRY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />OTNER <br />STATE BUIIDING SURCMARGE <br />PUBLIC WORKS <br />TOTAL <br />