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� <br />t <br />r. .-, <br />APPLICATIL.� FOR CONSTRUCti .ON PERMIT <br />CITY �F EVERETf • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />❑ DEMOLITION r'f COMBINATION ❑ BUILDING 1-1 MECHANICAL ❑ PLUMBING fl SIGN <br />PROJECT ADDRESS _., _ ,, _ <br />OWNER <br />TENANT <br />MAIL ADDRESS <br />GITY <br />ZIP <br />PHONE <br />PHONE <br />c�cw iyrii rY�r�c.vl�/UfGfel -JCN//LC� �l�rV ��/oJr /XVh—..[ya—toi7 <br />GENERALCONTRACTOR MAILAODPE55 GITV ].IP PHONE� .. ....._FiATELICENSFr <br />CONTRACT PRILE OF WORK <br />OESCRI9E WORK qND SOUPRE <br />LEGRL .D.�ESC�fl.IPT�ION OF PRpPF <br />LOT �� BLOCK <br />PAPCELTA%I.D.NUMBER <br />� lo/ �' <br />CONSTFUCTION LOAN LENDER, A[ <br />BELOW OR <br />_ OF� <br />TELEPIfONE NUMBER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) � <br />BATHTUB � <br />LAVATORY (WASH BASIN) ✓ <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKINC FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE -- BAR, ETCJ <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK � REAq SETBA� <br />�j /(/ <br />USEZONE �OTAPEA <br />�J <br />HEIGHTLIMITATI�JQ/ NOI,SFDWELLING <br />,, <br />P20'D <br />FIRE SPPIhN:ER REO'D <br />_N <br />'�/�/9s <br />SIDE SETDACN <br />FEE <br />HEATING SYSTEM: ❑ GAS p.ELECTRIC ❑ <br />CONTACTPERSONANDPHONENO� y l ^ .l` <br />✓/ i <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLIC4TION AND KNOI"! 1: IE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTI�G OF A PERMIT DOES NOT PR[SUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LA'W REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERT'f TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MAUE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 PCW AND 296.200 YlAC. <br />� � l � �9 r <br />-� � r� � � ai <br />X <br />SIGNATURE DATE <br />CIiV BUSINE55 UCENSE NO. <br />MECHANICAL <br />NO. TVPE OF FIXTURE OR ITEM FEE <br />A/C — AlHNDLG UNITS — H.P. � <br />FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br />HEAT PUMP i <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 BURNING) i <br />FIREPLACE INSEFT (WOOD BURNING) � <br />GAS FIREPLACE ; <br />GASRANGE � <br />GAS PIPING ' <br />/ EXHAUST FAN ! � <br />SUB TOTAL $ <br />PERMIT S <br />TOTALFEE $ <br />PLANCHECKNUMBER / I FEE _ LRECEIPTNO. <br />VACANT SITE / FEES " <br />flYES fi NO pU1L�ING 47�( <br />SI2�yE O�F B�LOG/TI. /� �T <br />VC7�� S F /+ P�UM9ING <br />BASEMENi � � MECHANICAL <br />❑YES fWCO <br />PODIT10NAr. PIAN CNECK <br />OTHER <br />STATE B111L�ING SURCHARGE <br />CITY OF EVERETT rueucwoaKs <br />LOCAL SALES <br />� TAX CODE IS 3105 TOTAL <br />2 <br />