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APPLICATIO.� FOR CONSTRUCT►.iNl PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-BB70 <br />❑ DEMOLITION ❑ CO/�MBINATION ❑ BUILDICN�G ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT AODRESS: / I�i�.-i `T � - �) �1� <br />ecm <br />ZIP DIIONE <br />GENER�ICOHiR�CTOq M�IL�DDRE55 CIIY )iP P��ON[ SI�TEUCENSE• <br />MECNANIG0. CONTR�CTOR MAII �DDRESS f.ltt ZiP VIIONE SiATE I�CENSE � <br />PIVMBING CONTR�CTOiI MARl�OpRE55 CIfY zlP PHONE ST�TE LICENSE � <br />CONTRACT PRICE OF Mp111( <br />oescn�qe won�A- NO SO�MRE FQOt� E�IN�ave ./ <br />IC K � << ., <br />✓� _,n �� , �i <br />LEG�l0E5GPIPTION OF PROPERtt (�� �IOW OR �TTACH TWO COPIE5) <br />LOT BIOCK OF <br />PAqCEL TAI(1.0. HIIMBEH <br />CANSTRUCPON LONI LENOER, ADDRESS. TELEPHd�E NUMPcq <br />1 <br />� PLUMBIIf6 <br />i NO. TYPE OF FlI(T11RE OR ITEM <br />WATER CLOSET (TOILETI <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />— BAR. <br />SUB TOTAL f <br />PERMIT S <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />IRONTSETBACK RE�RSETB�CK S�DESETB�GN <br />USE IdlE <br />NEIGIIT LIMIiATION <br />OLGUP�NCY NO bf5 <br />GRWP <br />FlRE SPRINKLER PEO'D <br />FIRE AIAfiM REO'D <br />rrre oF r.ovsr <br />FEE <br />HEATING SYSTEM: ❑ GAS O ELECTRIC O <br />CONT�Ci PERSON AND PNq1E NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS <br />APPLICATION AND KNOW THE SAME 1 O BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEF;NING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRAN7ING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTNORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR lHE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPIY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />x �m � l�✓ <br />SION�TURE D�TE <br />CITY 6USINE55 UCENSE NO <br />NO. I TYPE OP EQUIPMENT I FEE <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORVERS <br />MEfAL FIREPLACE (WOOD <br />FIREPLACEINSERT�WOOC <br />GAS FIREPLACE <br />G.4S RANGE <br />GAS PIPING <br />E <br />E <br />a <br />Pl�NC11ECRNUMOER � �EF I AECf:IPTNO. <br />IOi�BEA VAC�NTSIiE YCCJ <br />❑YES ❑ NO OUIL�INR <br />NO OF OWEIUNG S�ZE OF BIDGRI <br />UNIiG Pl11MpING <br />OCCUPANiLO�D BASEMENT MECNeNIC.�L <br />❑YES ❑ NO <br />REASON �DDIIIONAI. �UN CNf.CN <br />OIHER <br />PEAGOM <br />STAIE UWtDING S�I�GIIRRGE <br />Pinr�s��rnoveo er CITY OF EVERETT ruenr, wonres <br />LOCALSALES <br />,,,,� TAX CODE IS 9105 TOTAL <br />