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APPLICATIV�1 FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREFT • EVERETT, WA 98201 • 259•8810 <br />f7 DEMOLITION fl COMBINATION ❑ BUILDING �('I MECHANICAL ?LUMBING f� SIGN <br />PROJECT ADDRESS � � ✓ / <br />�/ n Gi /� .,,.� i�/." r. .i-77 .�1�%'1.�� <br />IENRNT <br />MAILADDRE55 <br />....�,..,.,,, .,.,,,�.� ...,�6 �nOf ,�� — <br />DESCRIBE WORR RNO SOUARE FOOT�GE INV01`:E� <br />cm <br />� <br />cirv <br />CIiV <br />an <br />GIiY <br />LEGAL DESCRIPiION OF PROPERTY (SHOWN BELOW OR �TTA.^.M N�O COM'e5) <br />LOT BLOCK OF <br />PARCELiA%IU.NUMBER / <br />��� - �U� -<J��Y lJ/lJ . <br />CANSTRUCTONLO/JILENOER.ADDPESS,TELEPMONENUMBEP <br />PLUMBIN6 <br />NO. 7YPE OF Fl%TURE OR ITEM FEE <br />CLOTHES WASHER <br />URINAL <br />DRINKINO FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTE <br />SINK (SERVICE — BAR, <br />SUBTOTAL $ <br />PEFMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBRCK RERR SETBACK <br />USEZONE LOTAPEA <br />HEIGIITLIMIiRION NQOFDWELLING <br />UN17S <br />FIRE <br />OFCONST <br />OATE <br />PMONE <br />lr/��U�U � J � S " ( / / ��L- <br />ZIf' PHONE,r �_ , SiPTE LICF.NSE � <br />21P PHONE STATE UCENSE � <br />ZIP PHONE $TATELICENSE� <br />HEATING SYSTEM: Y_f GAS O ELECTRIC f7 <br />LONTAGTPENSONANDPNONE NO _ <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 LAW� 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 />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OP LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROP TO ERFORM THE WORK FOR WHICH <br />APPLICATION I COMPLY WITH -THE STATE <br />CONTRPC C AND 296200 WAC. <br />X � <br />S�GNATURE DATE <br />CITV BUSMES.^ LICENSE NO. <br />A/C —A/HNDLG UNITS — H <br />FORCED AIR SYSTEMS — E <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN _ <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD <br />FIREPLACEINSERT(WO00 <br />GAS FIREPLACE <br />6ASRANGE <br />GAS PIPING <br />E%HAUSTFAN <br />SI�ESETBRCK PLANCNECIy�IUMBER <br />L a <� <br />vncnnr sire FEES <br />IlVES ❑ NO BUILOING <br />SIZE OF BIDG/TI. <br />PWMAMG <br />BASEMENT M[CMRNICRL <br />f.IYES fi NO <br />— A�DIPONRIPLANCNFCK <br />O7NER <br />STAtE BUIIDING SIIRGNARGE <br />CITY OF EVERE7T Pueiic wonKs <br />LOCALSALES <br />TAX CODE IS 3105 , TOTAL <br />SUB TOTAL <br />F�RMIT <br />1 OTAL FEE <br />FEE I RECEIPT N0. <br />FEE <br />