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APPLICATIC11 FOR CONSTRUCT"�N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL O PLUMBING ❑ SIGN <br />__...___ ......._.... � ,. � ,�,, �,n . _ � I <br />��n,...,,� <br />�� <br />_...._.. � _�..�......�» �,,. .,� .��r� <br />N <br />TENMlT �/� MARADDRE55 �ITY 21F PnOHE <br />�} <br />•RCHItECTORDE51GN{E�p MIUTAD�RE55 �IIY IIP PMONE <br />% f / � <br />GENERNCONTFALTOf1 MULMDRE55 CIIV 2iP P110NE SIqEtICENSE� <br />NECHANICAICONTR�CTOR MAIIADONE55 CITY ZIP FIIONE STATEUCEhSE� <br />GIUMBWGCONTR�CiOR MAILADDNESS CIfY pP PHONE SiATEUCENSE� <br />OESCRIBE MqRK AND SOU�RE FOOT/�GE �NVOLVED <br />�R/�CN TVIO CO%ES� <br />LOT BLOCN <br />CWSTRIICTIqN lON1 LENDER. MDRESS, TEtEP110NE NUMBEq <br />PLUMBING <br />NO. TYPE OF FlXTURE OR ITEM <br />WATEF CLOSET (TOILEn <br />BATHTUB <br />UVATORY (WASH BASINI <br />L\UN�RY TRAY <br />CLOTHES WASHER <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SINK (SERVICE — BAR, <br />SUB TOTAL f <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />fPONTSETP�LN RE�RSETBACI( <br />USEZONE L0111nEA <br />MEIGIIT UMIT�TION NO OF DWCIUNG <br />UNIi$ <br />OCCUPl1NGY NO (% 51[NUES IX:CUP�NT t0�0 <br />GfiWP <br />FIHE 5. VKIER REO'0 RE�SON <br />FlREAIMMREO'D RE�SON <br />TYPEOff,pNST PlANSAPPf10�'EC <br />D�TE <br />SIOE SETB�CN <br />V�C�NI SITE <br />❑VES ❑ NO <br />SIZE O� BIDG�f I <br />❑YES ❑ NO <br />HEATING SYSTEM: � GAS O ELECTRIC ❑ <br />CONT�CT PEHSON ANO PHONE NO <br />I HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILI BE COMPLIED W!TH WHETHER SPECIFIED HEREIN OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCE� THE PROVISION OF ANY <br />OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERF09M THE WORN FOR WHICH <br />APPLICATION IS MADE ND I COIaPLY WITH THE STATE <br />CONTR R$�LJ�Yy . RCW AND 296200 WAC. <br />/ {�e > / <br />X 1!\ 1 S �> � <br />SIG R D�IE <br />CITY BUSINE55 LICENSE `!O <br />NO. TYPE OF EOU <br />A/C — A/HNDLG UNITS <br />FORCED AIR SYSTEMS <br />UNIT HEATEFS <br />CLOTHES DRVERS <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />FIREPLACE INSERT <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE S <br />ri�u c �ECK �+uuni n I rcF � nEci.mi Ho <br />OWIOMG <br />PlUG01NG <br />A1ECN�NiCM <br />RDDI IIONRL P.AN CII(CN <br />Ot11EN <br />STAIF BUIlDINO 91RGIUqf.E <br />CITY OF EVERETT runiir.wonKs <br />LOCALSALES <br />TAX COUE IS 3105 TOTAL <br />