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APPLICATIA FOR CONSTRUC&N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, VIA 98201 •257-8810 <br />❑ DEMOLITION ❑ COMBINATION 5r BUILDING O MECHANICAL ❑ PLUMBING ❑ SIGN <br />ADDRESS <br />LA. <br />DESCNER <br />zm <br />0/. <br />/8- <br />-9 200 <br />SATE LICENSE. <br />CONTR .1 PACE n4 -/ _ <br />L1/ <br />rvavE <br />CESCRIDE WORKa SGUAREE A.E INVOLVE' <br />d.m6 <br />HEATING SYSTE GAS ❑ELECTRIC ❑ <br />CONTACT PERSON AND PNONE 14 <br />Orr <br />/lam• L I <br />�' �'$'� r A �• ^'&� OBEµ <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 TYPE 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 STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X V Q��- Irf6l do <br />•S <br />PROPOSED USE OF BUILD". / <br />'S. ri �ESlel EAI C <br />LEGAL DEES�C�RIP1� ONN(WPPOI ISKOYN BELOW OP ATTACH TWO cavlur <br />LoII�l_%GOK�OE • <br />I <br />f J� i ! A e E I)F— <br />.�. <br />vAPCEL rAK D rmunEN <br />oo3ao � l S <br />CONSTRUCTION LOAN LErwER EESEIEPIwNE NUMBER <br />. <br />SIGNANDE DATE <br />CITY BUSINESS LICENSE rw <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO.1 <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C —NHNDLG UNITS <br />BATHTUB <br />Z <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />— <br />SHOWER <br />UNIT HEATERS <br />/ <br />KITCHEN SINK $ OISP <br />CLOTHES DRYERS <br />i <br />/ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />I <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />I GAS RANGE <br />SINK(SERVICE — BAR, ETC.) <br />! <br />GAS PIPING <br />EXHAUSTFAN <br />i <br />SUBTOTAL $ <br />SUBTOTAL S <br />) <br />PERMIT $ <br />PERMIT S <br />TOTALFEE S I <br />TOTALFEE S <br />FOR OFFICE USE ONLY: /1 9 - 03 / <br />FRONT SETBACK <br />REAR SETBACK <br />log <br />BIDE SETBACK <br />PIANCHECKNUNBER FEE <br />RECEIPT NO <br />USE ZONrt& / <br />UOTA�REJA/ <br />�j (j 3 <br />VACANT SITE <br />'�MEs ❑ No <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />1 <br />HE,GHT LLLIITAT <br />Z <br />NO OF MELLPG <br />KNITS <br />SNECFBI <br />r00 S <br />PLUMBING <br />y- <br />OCCUPANCY Np Ci B10R[S <br />OEM <br />"U- <br />OCLUPANi t0A0 <br />BA EN��f <br />dFEs ❑ NG <br />YECNANCAL <br />ADDNNNIALPIAN CNLCK <br />'IRE RRE00 <br />f�T <br />REASON <br />/-0 <br />OTHER <br />FIHEALARYRE00 <br />HEASCN <br />STATE BUILDING SURCHARGE <br />' <br />TYPE OF COUNT <br />PlANSAPPROVEoeY <br />DAZE F/ L2. oO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />