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- .�. <br />APPLICAT14r1 FOR CONSTRUC? �ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />.i200 CEDAR STREET • EVERETT. WA 98201 • 259-8810 <br />f7 DEMOLITION �CUMBINATION <br />PROJECT ADDRESS , � �. ,� <br />•DURESS <br />fl BUILDING n MECHANICAL r l PLUMBING �l SIGN <br />Sfi . SW. ,�.v-c_V��� <br />ARCHfT[CTOROESIGNER MAILADDRE55 �ITY JIP PHONE <br />OENEP�LCONTMCTOq M�IL�DDRESS _ �Itt � IIP PIIONE SIAiELICENSE� <br />n <br />OF WORK <br />i`YnU SO(U��A�RE FOOTAGE <br />d� J04 �/��: <br />I�G �� \ <br />'JnQI - 1 <br />F B��LDINq � <br />�Ew� oescmrnora oF eaovi <br />LOT'� BIOCN <br />� . � ,. _ _ <br />�'1–fv"� <br />:nori �ou� ier�men. u <br />VQ <br />TYPE OF <br />WATER CLOSET� <br />BATHTUB <br />LAVATORY(WASF <br />SHOWER <br />KITCHEN SINK 8 <br />�ISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHE <br />URINAL <br />DRINKING FOUM <br />��� <br />�� <br />�_� <br />t <br />ESS.TELEPHONENUMBER <br />RURE OR ITEM <br />BACKFLOW PREVENTE <br />SINK (SERVICE — BAR, <br />SUB TO <br />PERMIT <br />FOR OFFICE U3E ONLY: <br />FRONTSETBAC� r REMSETBACK <br />C �' /p ' <br />USEIONE LOT�R <br />_ �'� �/ 3� <br />HEIGMTUM11ALn� r NO.OFOWEILING <br />J UNI7S <br />lOAO <br />fN1�9 <br />IICENSE <br />� <br />HEATING SYSTEM� ,iCLGAS �l ELECTRIC fl <br />��lJi�/Jt�1�� �Ii�e <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 GOVERNIN6 THIS TYPE OF <br />WORK WILL BE COMPLIED WI7H WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REOULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PEPFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 RCW Ah0 296200 WAC. <br />� � � �Y � <br />SIGN�T U4TE <br />CITY BUSINE55 LICENSE NO. <br />FEE P10. TYPE OF EOUIPMENT <br />' A/C—A/HNDLOUNITS—H.P. <br />� FORCEDAIFlSYSTEMS—B.T.U. M E.A. <br />� HEAT PUMP <br />' UNIT HEATEFS — B.T.U. M <br />� � CLOTHES DRYERS <br />S <br />S <br />SIDE SETB�CN <br />,j d / L� i <br />VACANT SITE <br />�S f i NO <br />SIZE OF BL 1 <br />C�3' 62 S <br />BA MENT � <br />f1VE5 VNO <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATEH <br />WOODSTOVE <br />ME�;AL FIREPLACE i <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />PLAN CIIECK NUMBF.R <br />��{�� <br />BUILDING <br />PLUMBING <br />MEGNnNIGRL <br />AOUIIION�I. PIAN G�f.CK <br />O1HER <br />STAIE BUIIUINC SURCHARGE <br />CITY OF EVERETT raeur, wonKs <br />LOCALSALES <br />TAX CODE IS 3105 70TAL <br />SUB TOTAL $ � <br />PERMIT E � <br />TOTAL FEE S � <br />FEE RECEIPTNO. <br />VALUATION FEE <br />� r i ) � <br />� �,=� <br />7� i �� <br />i <br />�p C','J i O L.� <br />� <br />i <br />i <br />i <br />� <br />i <br />i <br />i <br />�s� <br />� <br />i <br />�'_ <br />.-J:? 'i['1 <br />�� <br />�lil�� •.J <br />� <br />, <br />FOR OFFICE USE ONLY <br />ADDRESS _ <br />(1) BUILDING PERMIT FEE <br />(A) PLAN CHECK FEE <br />(2) PLUMBING <br />(3) MECHANICAL <br />' (4) STATE SURCHArIGES <br />(A) BUILDING CODE <br />(B) ENERGY CODE <br />(5) DRIVEWAY PERMIT <br />(6) WATER SERVICE TO BE PAID PNIOR TO BUILDING PERMIT ISSUANCE <br />(A) TO BE DETERMINED BY BLDG. INSPECTOR INCH <br />(B) EXIST. WATER SERVICE. APPLICATION NO. _ <br />(7) STATUS OF SEWER CHARGES: <br />BOND DISTRICT FOO'fAGE <br />N, S, E, W <br />SYSTEMS DEVELOPMENT <br />WATER <br />SEWER <br />TOTALORD. FE"t <br />SEWER CONNECTION CHARGES <br />YEAR TRUNK <br />LATERAL <br />T07AL CONNECTION CHARGES <br />SEWER PERMIT FEE <br />$ <br />:� <br />$ /DS <br />�`� <br />'�d ,-�' <br />$ �� <br />