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APPLICAT10000R FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT. WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION C BUILDING ❑ MECHANICAL 06-4LUMBING ❑ SIGN <br />PROJECT ADDRESS: 7/ - /C/� 67L16— S•eI <br />Sr/riGA'L LhKD", CH"AC.(q may= c/-II <br />ONMEP MAIL ANNE SS C,IY !In PHONE <br />1FNANT MAIL AINMrSS blr nP plg <br />OR CE51GNFR 4A.1 <br />GENERAL CONTRACTOR MAIL AGGRESS CH, IF PNONE STATE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADORE SS CITY !IP PHONE STATFLICENSE" <br />L--mV PFUMBING HTRAD�A,ES"L-TION LACQ/wcRE SS CG S%I S� IIY U ~r1 9�9UPIgNI STATE C7'RMS$E 9 <br />/�/�/'/L/ <br />CONTRACT PEACE OF WORM <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />GF SCPoBEWOrIK A NO SQUARE rO'JTAGE Fllm O ^ <br />CONTACT PERSON AMI PHONE NU <br />2 2 Sn-1!c <br />L 2�L-1 <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 1 COMPLY WITH THE STATE <br />CONTRACTORS LAAWW�18.27 RCW AND 296.200 WAC, <br />X — ^`(1 \/ �2 <br />PRDPOSED USE GE BLALmNG <br />LECALDESCRPTIIN OF PROPERTY ISIIOWN BCLOWORATTACH EACCOPHS) <br />LOT BLOCK Or <br />PARCEL TO I D NUMBER <br />CONSTRUCTIONLOAN IENCFIFADDRESS, TEICPN IE NU4BER <br />SIGNAIVRE CG 2� r OA1E <br />CITY BULNESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C —A HNULG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER _ <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WISHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE ('WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />13ACKFLOW PREVENTERS <br />GAS RANGE <br />Z <br />SINK (SERVICE — BAR. ETC.) <br />---� <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL S <br />SUBTOTAL S <br />_ <br />PERMIT $ <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SE TRACK <br />nun SETBACK <br />SIUE SETBACK <br />TI.HCHr[K 1UMR(l1 <br />ILE <br />TIC(IHT NO <br />USE ZONE <br />LOT AREA <br />VACANI SHE <br />FEES <br />VALUATION <br />FEE <br />nmmwD <br />❑lls ❑ N. <br />HEIGIRLIMUANCH <br />HD Or DWELLING <br />SIZE or EFILKI <br />uwTS <br />POEWING <br />T <br />OCCVPIHLY <br />cnO P <br />7w IN 517I$ <br />OCCUHANI LOAD <br />BASF4ENI <br />Mf(IIANICAI <br />❑YCS ❑NO <br />ADO 11n4AL Pt N Cll(CT <br />FIRE SPRINKLER nEOO <br />RusoN <br />Ourtn <br />FIRE AIMMPEOD <br />PF 4fN1 <br />STATE rR GNr. SIIFICHARGE <br />rvPE W roNST <br />rL nH$.rrnov(nm <br />CITY OF EVERETT <br />runur. vmnes <br />LOCAL SALES <br />- <br />TOTAL <br />— — <br />— <br />. A,E <br />TAX CODE IS 3105 <br />