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APPLICATIdr1 FOR CONSTRUC�'rJN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION �COMBINATION ❑ BUILUING ❑ MECHANICAL ❑ PLUMBING C] SSGN <br />!/.i��� — <br />lEN T MNLGDDRE55 CIiY 11p PIIONE_ � <br />PLUMBING CIXJTRACiOii M�IL ADORE55 Qtt IIP PNONE ST�TE LICENSE � <br />OESCPoBE WONN �ND <br />LEML OESLRIVTION'JF Pf10P1 <br />LOT ��' BLOCK <br />fAN$1qlICT10N LOAN LENDER, ADDRESS. TELEP110NE NUMOEN <br />PLUA�IN6 <br />N0. TYPE OF fl%TURE OR ITEM <br />� WATER CLOSET (TOILEn __ <br />BATNTUB <br />LAVATOftY (WASH BASIN) <br />SHUWER <br />KITCHEN SINK 8 DiSP <br />DISHWASHER <br />LAUNDRVTRAY <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ET <br />� <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FHONT SETBACK REAP SETBACN SIDE SETBAGI( <br />21�� ?id I <br />USEZONE 7 <br />� J` <br />NEIGNT LIMIT�TION <br />�C� l <br />0 <br />l0T AREA <br />NO O: LWELLING <br />UNITS <br />VACANT SITE <br />❑YE. ❑ NO <br />;iBS.h�� U�/i�v4 <br />❑YES �+O <br />HEATING SYSTEM: ❑ GAS @ELECTRIC <br />CONTACi PERSON NIO PNONE NO <br />I HEItEBV CERTIFY THhT I HAVE HEAD AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING iHIS TYPE OF <br />WOHK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF At.Y <br />OTHER STATE OR LOCAL LAW REQULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAi I AM AUTHORIZED BV THE <br />OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOF WHICH <br />APFIICATION IS MADE AND 1 COMPLY WITH TNE STATE <br />XO_CAC'c�-,ic–r � _�Z�—"tc1N t: 2;" AEX�C= <br />SION�TURE - ��✓ D�TE <br />CITY BUSINESS IICENSE NO <br />MECHANICAI <br />TYPE OF EQUIPMENT <br />iNDLG UNITS <br />FORCED AIR SYSTI <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />WATER HEATER <br />WOOD STOVE <br />MEfAL FIREPLACE � <br />FIREPLACEINSERT <br />GASRANGE <br />PUN CIIECN <br />S_ < <br />OUIl01NC <br />PLUMBING <br />MEf.HANIL�L <br />RF.ASON AODIIION�I f'L�N C��F.CN <br />O1HER <br />AEAgpN ' <br />ST�IE BUILDING SllfiCHRf1GE <br />DAIE <br />CITY OF EVERETT run�ir.vmn�s <br />LOCALSALES <br />TAX CODE IS 3105 7oTAL <br />SUB TOTAL S <br />PERMIT f <br />TOTAL FEE S <br />RECEIPT NO <br />FEE <br />� <br />�� <br />�� <br />