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APPLICATA FOR CONSTRUC*DN PERMIT <br />CITY OF EVERETT A BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •257-8810 <br />❑ DEMOLITION ❑ COMBINATION R BUILDING 0 MECHANICAL ❑ PLUMBING G <br />ADDRESS <br />MAIL ADET ESS <br />nv <br />GENERµ DONTRACigI MAILADDRESS CITY <br />PHONE <br />PLUMBnp gONT ACTOR MAILAGGRESS City ZIP MgNE STATE LICENSE <br />corvr�lAcr R� _E of woRK <br />N oc� <br />�� <br />HEAT ❑ GAS ❑ ELECTRIC n - <br />B <br />OE$CRIS WORKANG SO'JARE f001AGEINV0.VEG <br />'gf., l,✓ /oY/!1 QPr� + Lr�r� 2L <br />CON IPER It PHONE NO <br />I AF'lf <br />PRDvos£D USE oP WADING` <br />L[GALDI,Z' w— URI Of PROPERTY ISZ BELOW OR NTACH TWOCOPIES) <br />LOT BLOCK of <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL - <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />ITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />EAANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />TION IS MADE AND I COMPLY WITH THE STATE <br />CTORS LAW 18.27 RCW AND 296.200 Wt C. <br />� _ <br />Cam— 3-_ _YO/ <br />L <br />_ <br />PARCEL lAM ID IwuaER <br />�b�/37.� f�29Q'TE <br />COII$IRIIC,IGN LOAN LENDER. ADDRESS. TELEPHONE MIMBER <br />DATE <br />iESS LICENSE NO <br />ICAL <br />TYPE OF EQUIPMENT FEEWATER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />CLOSET ITOILET) <br />IC — A'HNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK & DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />• CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />j <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />i <br />GAS FIREPLACE <br />_ <br />_ <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />_ <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />I <br />1 <br />SUB TOTAL S <br />I <br />SUB TOTAL S <br />PERMIT S <br />_ <br />PERMIT S <br />_ <br />TOTAL FEE S <br />i <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />RAN CHECK NUMBER <br />0FE <br />FEE <br />RECEIPT NO <br />us;•zoNc <br />LOTAREA <br />VACANT SITE <br />DYES ❑ ND <br />FEES <br />VALUATION <br />FEE <br />BODING <br />NEK1NL lIMIiAtgI1 <br />OWEIIING <br />UNITS <br />UNITS <br />$IZE OG BL0G41. <br />FILMINGOCCUPANCY <br />GROUP <br />NODFS-.1 <br />OCCUPANT l0A0 <br />BASEMENT <br />0 vE5 ❑ tro <br />MECHANICAL <br />ADDITIONAL PUN CHECK <br />FWE SPRINKLER REOD <br />REASON <br />OTHER <br />"HE ALARM RED 0 <br />REASON <br />STATE BUILDING suRCNMGE <br />TYPEOF COTIST <br />PLANS APPROVED BY <br />DATE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 31Se I <br />PUBLCWDRKS <br />liTeL <br />I2S <br />