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...-Y, _-_.. <br />APPLICATI�..�i FOR COWSTRUC`� .JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />� 3200 CEDAR STREET • EVERETf, WA 98201 • 259-8810 <br />❑ DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING �'SIGN <br />PROJECTADDRESS ni _,� --_ , / _ <br />OWNER MAILAUDRESS CITY 21P PHONE <br />�tl/A <br />PLUMBINGCONTRACTOR MAILADDPESS Cltt ZIP PHONE STATELICENSE� <br />CONTRACTPRICEOFWORK t ��� Ov <br />•T <br />OESCRIBEWORKANDSQUAREFOOTA EINVOWED <br />�5 �' ( � .� +✓n ll 5 SriS <br />� � ..... � J- � „.l- 1'u'� v /�_ � <br />/ I vIT• - 7t..r..1 <br />LEGAL �ESCRIPTION OF PROPE <br />LOT _ BLOCN <br />PARCELTAXI.D.NUMBER <br />iNSTBUCTION Lp�1N LF��1�ER, AODRE55.7ELEPHONE NUMBER <br />��U%% \ <br />_UMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />FOR OFFICE USE ONLY: <br />FfiONTSETBACK � RE�R: <br />USEZONE / <br />�/� f <br />HEIGHT LIMITATION <br />OCCUPANCV NOAFST( <br />GROUP <br />FIRE ALARM FE�'D <br />FIME SPPINNLER REO'� <br />LOTAREA <br />SUB TOTAL S <br />PERMIT $ <br />TOTALFEE S <br />- A T�� 5�0� <br />NO. OF DWELLING <br />UNITS <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACTPEPSONANDPI�IONENO. � M ^ 3sS-dfl�y <br />��_ „�� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PtRM1T DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTFUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION -fHAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WiTH THE STATE <br />CONTRACTfj6i6,LAW 1827 ND 296200 WAC. <br />r i , ) <br />� i..t /� ��i "�/S <br />X � DATE <br />SIGNATURE <br />n 30�39 <br />CITV BUSMES$ LICENSE NO. _ <br />Np, TYPE OF FIXTURE OR ITEM <br />A/C - AMNOLG UNITS - H.P. <br />FORCED AIR SYSTEMS - B.T.U. M E.A. <br />UNIT HEATERS - B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN _ <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD <br />GAS FIREPL <br />GAS RANGE <br />SUB TOTAL S <br />PERMIT S <br />TOTP.L FEE S <br />PLAN CMECK NOMBER_ I FEE �� r�-I RECEIPT NO. <br />VACANT SITE <br />❑VES ❑ NO BWLOING <br />SIZE OF BLWR.1. <br />PLUMOING <br />6ASEMENT MECMANICAL <br />❑YES ❑ �JO <br />ADOIPONAL PLAN CMECN <br />OTHEfl <br />STATE BUILUING SURCHARGE <br />CITY OF EVERETT PUBLIC WOFKS <br />Lr,CAL SALES <br />) TAX CODE IS 3105 70TAL <br />� <br />/I <br />