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APPLICATI(�1 �4�i CO�ISTRUCZY DN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-BB10 <br />O DEMOLITION ❑ COMBINATION c BUILDING ❑ MECHANICAL ❑ PLUMBINI ❑ Sl(3N <br />MECNANICALCONTRICTOR M�ILACDRE55 CI7Y TIP PHONE ST�TELICENSE� <br />PLUMBINGCONTRACTOR M�ILAOORESS LIIY 21P PHONE STATELICENSE� <br />DESCRIBE WORN �NO SOUARE <br />LOT BIOCK <br />l:ON57l1UCTION IO/�N LENDER, AWPEGS. TELEPIqNE NUMBER <br />TYPE OF FlXTURE OR ITf.M <br />WATER CLOSET (TOII.En <br />UVATORY <br />KITCHEN SINK S DISP <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />DRINKINO FOUNTAIN <br />FLOOH DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ET <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USF ONLY: <br />FRONT SETBACK RE�R SETBACN SIOE SETO�CN <br />USE 10NE l0� AREA V�CANT S�TE <br />❑YES ❑ NO <br />NEIGNT LIMITATION NO OF OWELLIA3 SIIE OF BLOGRI <br />UNIfS <br />I I I �YES ❑ NO <br />fIRESPRINNLERREO'D �7E�SON <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS �105 <br />HEATlNG SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONI: GT PERSON �N� PHONE Np <br />I HEReO'! CERTIFY THAT I HAVE READ AN� E%AMINED THIS <br />APPLICA'�ION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIJNS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OH <br />NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REOULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTFUCTION. THAT I AM AUTHORI2ED BV THE <br />OWNER OF THIS PFOPERTY TO PERFORM THE WOqK FOR WHICH <br />P ICATION IS MADE AND I COMPLY WITH THE STATE <br />T ACTORS L 18,27 RCW D 296200 W!�C. <br />0 <br />51(3NATU DAIE <br />CITY BUSI ESS IILEN E . <br />NO. TYPE OF EOUIPMENT FEE <br />A/C—NHNDlO UNfTS � <br />FORCED AIR SYSTEMS ; <br />HEAT PUMP , <br />UhIT HEATFRS � <br />J <br />�LOTHES DRVERS ; <br />RANGE HOOD � <br />WATER HEATER � <br />WOODSTOVE � <br />MEfAL FIREPLACE (WOOD BURNING) ' <br />FIREPLACE INSERT (WOOD BURNING) � <br />GAS FIREPLACE � <br />GASRANGE ; <br />GAS PIPING � <br />IXHAUST FAN _� <br />i <br />SUB TOTAL S ; <br />PERMff S � <br />TOTALFEE S ' <br />AY CIIECK NUMBER FEF NEf.EIPf NO <br />�a 3 �� <br />BUILO�N6 <br />PLUNBING <br />MECNIINIL�L <br />ADDI IION�L PUN CHf.CN <br />011�ER <br />STAI E B W 101N0 5110CNMIGE <br />rueur,wonKs <br />TOTAL <br />