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APPLICAT14.i FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING f� MECHANICAL rl PLUMBING (-1 SIGN <br />PROJECT ADDRESS <br />ARCNITECTORDESIGNER 6IAllA0DRE55 Cltt ZIP PHONE <br />MAILADDRESS <br />� <br />ZIP PNONE STA1E <br />21P FHONE <br />PWMBINOCONTR�CTOR MRILA�DRE55 CITY ZIP PHONE STATEIICENSE� <br />CONTRIICT PRICE OF WOBK <br />DESCPoBE NORK AND <br />r. <br />PROPOSEO USE Of BUILDIN(3 <br />� tii4.L <br />LEOAL DESCRIPTION OF PROPERTY (S <br />LOT BLOCK _ <br />� <br />�,.,.«aoa �o����/ o �� ov� � <br />CONSTRUCTON �OAN LENDER, AWRE55, TELEPMONE NUMBER <br />WATER CLOSET <br />BATHTUB <br />LAVATORV(WAS <br />SHOWER <br />KITCHEN SINK 6 <br />OR ITEM <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONT�CTPERSONMIDPMONENO. _ <br />1 HEREBY CER7iFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIn :�n <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 CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNEfl OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW ND 296200 WAC. <br />.r.n I�i'Ctr ,,2.9/��— <br />SION�TURE � ATE � <br />CITY BUSINE55 LICENSE N0. <br />MECMANICAL <br />FEE NO. TYPE OF FlXTURE <br />� A/C—AIHNDLGUNITS— <br />! F(1GCFfl AIG RVSTFLAS _ <br />WATER HEATEP <br />WOODSIOVE <br />METAI FIREPLACE I <br />FIREPLACEINSERT <br />GAS FIRE?LACE <br />GA5 RANGE <br />OAS PIPING <br />EXHAUSTFAN <br />SU6TOTAL $ <br />PERMIT $ <br />FOR OFFICE USE ONLY: <br />FROMSETB�CI( REARSET9RCK <br />USEZONE LOTAREA <br />IIEIGHTl1MIT�TION NO.OFOWELLJNQ <br />UNITS <br />OCGUPANCY NO OFSTOFIES OCCUPANTIOPD <br />GROUP <br />FIREAURMREO'D REASIXJ <br />Si�E SETBACK <br />V�CANT SITE <br />❑YEb ❑ NO BUILDING <br />SIZE OF BLOGRI. <br />PIUMBINO <br />ASEMENT MECNANICAL <br />❑YES ❑ NO - <br />ADDITION,IL PIAN CHECN <br />OTHER <br />STATE BUIIDING SURCH�PGE <br />CRY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUBTOTAL S <br />PERMIT S <br />TOTALFEE S <br />FEE I RECEIPTNO. <br />