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APPLICATION FOR CONSTRUCTION PERMIT <br />CITY OF EVERM • BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT, WA 98201 A 257-8810 <br />DEMOLITION 0 COMBINATION ❑ BUILDING 0 MECHANICAL ❑ PLUMBING ❑ SIGN <br />KUNI CONtAACTOA A. ADDRESS GTr TIP <br />CDITRACT RACE OFw <br />HEATINGSYSTEM: ❑GAS 71ELECTRIC ❑ <br />D�SCPIBE N'CP6 ATq .WE i00 D <br />L� <br />CONTACT VCPSON Nq R101{Tq <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 GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOPITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WCRK FOR WHICH <br />AI ?J_ ATI IS MADE AND I COMPLY WITH THE STATE <br />CO T SLq. I � 18. 27 RCW AND 296200 WAC, <br />Y <br />X � l `1 `� 'FZ`/ —' <br />rmovoscD usEDeuwKlo <br />LEDAi DEscRRtaNaPrgrtRTr lslavm BELowwATTACH Two COPIE61 <br />LOT RaK D <br />PARCELTAK I D NUMBER <br />CONSTRUCTIONHONE PALMERALMLOAN LENDER. ADDRESS. TELEPHONE <br />SIGNATURE aATL <br />CITV BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />ARC —A HNOLG UNITS <br />BATHTUB <br />I <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />i <br />UNIT HEATERS <br />KITCHE14 SINK B DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />i <br />RANGEHOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />I <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING! <br />FLOOR DRAIN <br />GAS FIREPLACE <br />SACKFLOW PREVENTERS <br />I <br />GAS RANGE <br />SINK (SERVICE —BAR. ETC 1 <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMIT S <br />PERMIT S <br />I <br />TOTALFEE S <br />! <br />TOTALFEE $ <br />FnG nFFICF IICF f)NLV! <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />LNCHECRNUMBER /� <br />/9 - OS <br />PEE <br />PECENTSO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DRS nw <br />FEES <br />VALUATION <br />FEE <br />BUIIDmD <br />HEgNTLNrtATION <br />OwFLLM6 <br />SIZED&oOtl <br />RUHBIHS <br />y <br />OCCIRANCY <br />OHO W <br />WOE6RFE6 <br />OCCIAAM LOAD <br />BAYMENi <br />❑ ES ❑ NO <br />MECHANC,LL <br />ALOOp11AL AAII CNECN <br />FRESNA MLERPE00 <br />REZ. <br />0M01 <br />FREAIAPMPEOO <br />PEKSON <br />B1A1E &AfMM 6UNLHARGE <br />TYPED DONST <br />PLANSAPPROVEOBY <br />VI <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC AORKS <br />TOTAL <br />