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APPLICATII..� FOR CONSTRUC7.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION fl COMBINATION fl BUILDING �4 MECHANICAL I� PLUMBING I-1 SIGN <br />ONNER <br />F�-Ks�t�ovr� <br />CONTRACT PRICE OF WORN <br />DESCRIBE WONK AND SOUAPE <br />USE OF <br />MAIL qDDRESS <br />MAILADDRESS <br />� <br />(SHOWN BELOW CRATTACH <br />LOT BLOCK _ <br />��,�%.��r <br />PM;ELTNtID.NU BER <br />F32 0�� 3 -c <br />CONSTRUCTONLO�NLENDER.ADDPES <br />PLUMBINO <br />NO. TYPE OF Fll(T <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORY (WASH BA; <br />SHOWER <br />KITCHEN SINK & DISF <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENI <br />�� — cs—�.� i <br />TELEPNONENUMAER <br />OR ITEM <br />SUB TOTAL $ <br />PERMIT $ <br />CITV ZIP <br />CITY � ZIP f'110NE <br />� �a�E.2E�l"' i� 2L� <br />7 cnv zir vNONe <br />?u.�se, <br />CITV Z�P PMONE STATE LICENSE M <br />CITY <br />FEE <br />FOR OFFICE USE ONLY: <br />FRQNTSETBACK REAR SETBACK SIDE SET�ACK <br />USEZONE <br />NEIGNT LIMITATION <br />OCCUPANCY NO OFSiI <br />GROUP <br />FIRE AURM REO'0 <br />FIRE SPHINNLER REO'� <br />STAiE I.ICENSE � <br />PHONE STATE LICENSE r <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND F.rJO,N THE SAME TO NE TRUE AND CORRECT. ALL <br />PPOVISIONS OF LA'JJS 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 GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGUTATING 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 />APPLIC IS MADE AND I COMPLY WITH THE STATE <br />CONT CTORS LAW 0.27 RCW AND 296200 WAC. <br />x ��� � �ir'-��� <br />SIGNFTUR � n�TE <br />CITY BUSINE55 LICENSE N0. <br />MECHANICAL _ <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />A/C —AMNDLG UNITS — H.P. ; <br />FORCED AIR SYSTEMS — B.T.U. M E.A. � i <br />UNIT HEATERS — 8. <br />CLOTHES DRYERS <br />VENTIt.ATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE ( <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE $ <br />PLANCIIFLI(MUNO[R _,., I FEE I RECFIPTNO. <br />LOTAREA VACRNTSITE �Cw <br />fIYES n N� BlI�l01NG <br />NO.OFOWE�UNG SIZEOFBLOGrt.I. <br />UNIT$ p�UM01NG <br />OCCUPANTIOAD BO.SEMENT MECN4NICAL <br />❑YES fl NO <br />FODIPONAL PIAN CNFCN <br />REASON <br />OTHER <br />REA30N <br />STAT@ OUILDING SIIRCH�RGE <br />PLANSAPPROVEDUY CITYOFEVERE7T Puci.icwonKs <br />JM ) LOCALSALES <br />�..� � lez/�flil TAX CODE IS 3105 70TAL <br />0 <br />