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—� ,er <br />APPLICAT14.�1 FOR CONSTRUC7.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 9820t • 259-8810 <br />f7 DEMOUTION f-I COMBINATION rl BUILDING I l MECHANICAL ( 1 PLUMBING fl SIGN <br />PROJECTADDRESS ;,�� �Din �. S� <br />OW`IER MAILA�ORESS CITY Z�n PHONF: <br />_ 1 � / � \ 1 _ _�. r _'��^ c 7 <. .� f _ :� Q O'�n7 �.F1�1 �1r1 l4 <br />TENAMT MAIL�[10RESS LITY 71P t'IION[ <br />ARGHRECTORUESIGNER Id�IIADDRE55 CITV ]IP PIIONE <br />GENEi7ALCONTRAJTOR MAILAOOPF:55 CIiY 71P PIIONF STNEUCGNSEd <br />MECHANICALCONTF4CTOR MAILADDRE55 CI7Y 7.IP PHONE STNELICEKSE� <br />CONTRACT 1�110E OF WORI( <br />DESCPoBE W RK AND SOUA . FOO' <br />p�Plit(lti r <br />PROPOSED USL OF B111�DING <br />LEGAL OESCRIPTIDN OF PROPERTV <br />LOT BLOCK _ <br />CURESS CI7Y ZIP �'�{ONE 9Are':IGhNSt M <br />-� . i L� ,�-, � -. `7� -oG� L Cxo. 2ob� / <br />g �� HEATING SYSTEM: 17 GAS ❑ ELECTRIC ❑ <br />. � <br />N LVEO f r^ /, ^ CONT�CT PERSON AND PHONE NO. , <br />rr_ 11_ _' '�L�-n7_L'l <br />LOW OR ATTACH <br />OF <br />PARCELTAXI.D.NUMBER ^ � � � <br />s 4 �(- ��b5�^ <br />CONSiRUCTIONLOAN LEN�ER,ADDRESS,TELEPIIONF NUMOEfl <br />PLUMBING <br />N0. TYPE OF <br />WhTER CLOSETi <br />BATHTUB <br />SHOWER <br />KITCHEN 51NK & DISP <br />DISHWASI'.ER _ <br />LAUNDRY'lRAY <br />CLOTHES'�NAiHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOVlPREVENTERS <br />SINK (SERVICE — BAR. El <br />FOR OFFICE USE ONLY: <br />FRONT SFTBACK FEAR SETBACN <br />USE ZONE <br />HEIGHT LIMITATION <br />OCCtlPANCv NOAFSi� <br />GFOUP <br />� _ <br />FIRE PLARM FEO'U <br />FIRE SPRINNLEP REGD <br />LOT AfiEA <br />ITEM <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE $ <br />NO OF�WEIUNG <br />UNITS <br />OATE <br />OV <br />FEE <br />SI�E SEIBACK <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 TVPE 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 STATF OR LOCAL LAW REOULATING CON�TRUCTION OR THE <br />PERFORMANI:E OF CONSTFUCTIUN. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />ApPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOR LAW 18.27 R AND 296200 WAC. <br />X DAT� ` a � <br />SIGN <br />CITV BUSINE55 LICENSE NO <br />MECHANICAL <br />NO. TYPE OF FIXTUHE OR ITEM FEE <br />A/C —MiNDLG UNIT3 — H.P. ' <br />FORCED AIR SYSTeMS —@.T.U. M E.A. ; <br />HEAT PUMP ' <br />UNIT HEATERS — B.i.U. M ' <br />CLOTHES DRYERS � <br />VENTILATION FAN _ _ ' <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACF. i <br />FIREPLACE INSERT <br />GAS RANGE <br />EXHAUST <br />S1�8 TOT:iL S <br />PERMIT 5 <br />TOTALFEE S <br />PLAN CIIECN NUMFILR I FEE I PECEIPT NO. <br />\'ACANT SITE rcc� <br />I l YE5 ❑ NO gUIL01NG <br />SIZE OF BLDGR.I. — <br />PLUM9!NG <br />BASEMENT MEC��ANICAL <br />❑YFS (l NO <br />AD�ITIONAL PLAN CHI:CK <br />O7HER <br />ST�T[ �WLDING Sl1PCNARGE <br />CI7Y OF EVEAETT PU�LIC WOPNS <br />LOCALSALES <br />TAX CODE IS 3105 70TAL <br />