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APPLICATIO J FOR CONSTRUCT:�JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 C;EDAR STREET • EVERETT, WA 98207 • 259-8810 <br />❑ DEMOUTION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL f7 PLUMdING ❑ SIGN <br />PROJECT ADDRESS ^ - ' ^ <br />OWNER <br />�zz <br />MAIL pDOR65S <br />zir <br />TENANT // MAILAOORE�S - CITY IIP / PNONE <br />V <br />ARCNITECT OR DESIGNER MAIL 4D�RE i5 CITY 7.IP PHONE <br />GENERALCONTRACiOR MAIL�O�REsS CIIY ZIP PHONE STATELICENSE/ <br />MAIL <br />DESCRIBE MIORK ANO SOURRE <br />INVOLVED <br />PROPOSEO USE OF BUILUING <br />LEGAL DESCRIP710N OF PROPERTY (SHOWN BELOW Ofi ATTACH <br />LOT _ BLOCK OF <br />PNiCELTN(LD.NUMBER <br />CONSTPUC710N LOAN LENDER. A�URE55, TELEPHIXJE NUMBER <br />PLUMBING <br />NO. TYPE OF flXTURE OR ITEM <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL 3 <br />PERM�T 5 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FROM SETBACK PEAR SETBAfN SIOE SETBACN <br />USEZONE <br />MEIGHT LIMITATION <br />Un <br />ilP PHONE STATE LICENSE � <br />ZIP Pf10NE ST�TELIGENSEr <br />HEATING SYST�M: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACTPERSONPNOFMONENO. <br />I HEREBY CERTIFY THA�! I HAVE READ AND EXAMINED THIS <br />APPLICAT�ON AND KNOW 7�HE SAME?O BE TFUE AND CORRECT. ALL <br />PROVISIONS OP LAWS ANG 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 OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PRUVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORRED BY THE <br />OWNER OF THIS PROPERTY TO PERFORN THE INORK FOR WHICH <br />APPLICATION IS MADE AND I COMP�/ WITH THE :'TATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 �7AC. <br />��� � <br />GNATURE � D�TE <br />CIiV BUSMESS LICENSE NO. <br />FEE NO. TVPE OF flXTURE OR ITEM FEE <br />—� <br />� AIC—AMNDLGUNITS—H.P. ! <br />' FORCED AIR SYSTEMS — B.T.U. M E.A. ' <br />� --T <br />� HEAT PUMP � <br />_�_ <br />� UNITHEATERS—B.T.U. M ' <br />' CLOTHES DRYERS � <br />i <br />� VENTILATION FAN ' <br />! RANGE HOOD � <br />WOOD STOVE <br />METAL FIREPLACE <br />GAS FIREPLACE <br />6AS RANGE <br />EXHAUST <br />TOTAL S <br />TOTALFEE <br />PUNCIIECKNUMOER , /� � FEE I RECEIPTNO. <br />IOTAREA �ACANTSITE rcw <br />IlVES fl NO BUILDING <br />NO.OFDWEWNG 512EOFBlDGRI. <br />UNIiS p�l1MBING <br />STOPIES OCCUPANTLOAD BASEMENT MECHANICAL <br />❑YES Il NO <br />REASON ADDITIONAL PLAN CHECN <br />OTNER <br />1'0 REASINJ — <br />STAiE BUILOMG SURCHARGE <br />PLANSAPPROVEDBY CITYOFEVERETT PUBLiCWORKS <br />LOCAL SALES <br />onre TAX CODE IS 3105 TOTAL <br />