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APPLICATI4.� FOR CONSTRUCT JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 982�1 • 259-8910 <br />[J DEMOLITION ,Q�COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PWMBMGCONTRI1CTOi1 M�ILAODRESS C!tt ZIP PHONE ST�fEIILENSE• <br />OESCPME WOIIK �NO <br />LEG/�!.OESCRIPiION OF PROPER� Y(SI�OWN Bk <br />LOT � BLOCN _ _ <br />CONSTRIICTION LOM! LENOER. AOORE55. TE�EP110NE NUA/BEH <br />X�.��(.5' - - <br />PLUMBING <br />NO. TYPE OF FlXTURE OR ITEM FEE <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LFNATORY (WASH BASIN) <br />SHOWER <br />�_ <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />UUNDRY TRAY _ <br />�_ CLOTHES WASHER <br />�J UHINAL <br />DRINKING FOUNTAIN <br />FIOOR DRAIN <br />� BACKFLOW PREVENTERS _ <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRdITSETBACN��, RE�ASF.T��CI( � <br />G � %� <br />I15E Z E/� lOT ANE� <br />.� � D,�f <br />HEII'+NT L ITATION _/ UNt � �N'ELLING <br />%��� <br />CJ <br />GCCUPANCY fq(%SI(NtlfS OCCUPANTLOAD <br />p.3 <br />FIRESGPINKLENflEO'D RF�SON <br />FIP.EAURMREO'D RFAc(� <br />TYPEOff,ONST PlANSAPPROVEDOY <br />��/ QJi��If <br />V � I / OAtF i/�ZO�"1� <br />SiOE <br />HEATING SYSTEM: ❑ GAS J�LECTRIC ❑ <br />CONT�CT PERSON ANO PHOf1E NO <br />I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS <br />APPLICATION AND KNOW THE SAME l'O BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDtNANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEHEIN OR <br />NOT. THE dRANTING OF A PERMIT OOES NOT PFESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISICN OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINCa CANSTRUCTIOP'. OR 1 r1E <br />PERFOqMANCE OF CONSTRUCTION. THAT I AM AUTNORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICpTION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA RS LAW 1827 H AND 296.200 WAC. <br />X �e�. �/���6� <br />SIGN�T�_-�L,Pe4/1re� D�TE <br />CITY BUSINESS LICENSE NO <br />NO. TYPE OF EGUIPM'cNT � FEE <br />FCRCED Alfi SYSTE <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE � <br />FIREPLACEINSERT <br />SUB TOTAL S � <br />PERMIT f � <br />TOTALFEE S ; <br />PI�NCNECNNUMBFRQ �EF f1Ff.F.IPTNO <br />J o7 ��.�J � .. <br />VAC�NT SITE <br />❑VES ❑ NO pUII�INC <br />S�IZEy� JO,F BLOGyR I <br />'�7' Sff LGAQ/��L PL174�OING <br />BASEMENT � � MFLH/1NICAL <br />❑YES 0�10 <br />eoomowe� rus c��ccK <br />0111E(i <br />STAIE BUIl01NG SURCHAIiGE <br />CITV OF EVERETT ���fl��� WnRKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />