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APPLICATI��J FOR CONSTRUC7�JN PERNIIIT <br />CITY OF cVERETT • BUILDING DIVISION <br />3200 CEDAP, S i REET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION p COMBINATION �UILDING ❑ MECHANICAL ❑ PLUMBING <br />❑ SIGN <br />PROJECT ADDRESS: �A. ,-c� v c n.,«�. EA,��. _, r,. .. _ I_ .. <br />MECHAN!CJLLCONTR�CTOR MAqADORE55 <br />��TM Z�� PIIONE STATE UCENSE � <br />PIUA�BINGCONTR�CTOR M�IlA0DRE55 CIfY <br />I��� M"j z�P PHONE STA�E UCENSE � <br />OESClMSE WpiK �NO Sd1ARE FOpTACE INVOUIED <br />4.I�.wr.IT � . _ . . <br />� <br />.ew� uex�nrnow oc anp� <br />LOT BLOCN <br />CONSTRUCTipN LOAN lENOER, �pppE55, TElEP1qNE NlA18EP <br />PLUM&NU <br />NO. TYpE OF flXTUqF OR ITEM <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 3 DISP <br />DISHWASHER <br />UUNORY TRAY <br />CLOTHES WASHEq <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTEFS <br />SINK (SERVICE — 9AR Frr. i <br />FOR OFFICE USE ONLY: <br />FRpHTSETBACN REARSETBACK <br />USE ZONE <br />NEICHT LIMIT�TION <br />OCCUPANCY Np pi <br />LOT�REA <br />SUB TOTAI S <br />PERMIT f <br />TOTAL FEE S <br />SIDE SFTB�Ck <br />N� OFOWEIL�NG <br />UNIIC <br />V�C�NI SIfE <br />❑YES ❑ NO <br />SIZE OF BIOG?I <br />❑YES ❑ NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTIICT PERSON AqD PHONE NO <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EJ(AMINED 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 WILI. BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE 3RANTING OF A PERMIT DOES NOT PHESUME TO GIVE <br />AUiHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULqTING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTqUCT10N. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />(��P ICATION IS MADE AND 1 COMPLV WITH THE STATE <br />�F�ACTOR>S.rAW 1827 RCW A�JO 296.200 WAC. <br />cm <br />TYPE OF EOU <br />NC—AMNDLG UNfiS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />�7.�1. _ � CtTd <br />WOOD STOVE <br />METAL FIHEPL <br />GAS <br />OWl01NG <br />PlUA1BING <br />AIECI4NIC�L <br />AODIIIONA�, PUA CNf:CIt <br />01NEf1 <br />STATC OUIl01NG 51111CH�fiGE <br />ruenr.woaKs <br />TOTAL <br />SUB TOTAL f <br />PERMIT S <br />TOTAL FEE S <br />fEF I �ECEIPTNO <br />