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APPLICATICS FOR CONSTRUCAN PERMIT <br />CITY OF -VERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVEERETT, WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION IT BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ <br />PROJECT ADDRESS: " R902 21 x A VG CF. <br />MUL ApCRESS CJry !IP <br />nr <br />MECHANICAL CONTRACTOR MAIL ADORES$ CITY <br />PHONE <br />STATE <br />CO.YTMCI P41C.Cf VpnN <br />HEATING SYSTEM: * AS ❑ ELECTRIC ❑ <br />SCIRIa RE FOOTAGE INV.IVEO <br />B <br />CONTACT PC fNtOlPHOHN3O3 <br />_21CI <br />Mfsfo D- - B sLs I�Uy <br />P&L" II 922-LI1T <br />f$32 GCIl'f100, �%$ <br />S - <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CL <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAITYPEOF <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING TFWORK WILL BE COMPLIED WITH WHETHER SPECIFIEDR _LEGAL <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUEloiI;u+cK <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCE <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 />CONTRAC RS LAW /18.�/27 RCW AND 296.200 WAC. n <br />Xl�l. 6-i-i7 <br />F�.I R S�dGALQ <br />SCNWI of Pn PEOIT ILIOWN BELOW gIAIIACH TWO COPIE91 <br />DF <br />PARCEL TAXI D. NUMBER <br />CONSTRUCTION LOAN LENDER. AWRESS. TELEPHONE NUMBER <br />SPAIWE DATE <br />CITY SHYNESS LICENSE NO _ <br />MECHANICAL <br />N0. TYPE OF EQUIPMENT FEE <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />3 <br />WATER CLOSET (TOILET) <br />© <br />A/C —AMNDLG UNITS <br />2 <br />BATHTUB <br />I <br />FORCED AIR SYSTEMS <br />3 <br />LAVATORY (WASH BASINI_ <br />p <br />HEAT PUMP <br />0 <br />SHOWER <br />C <br />UNITHEATERS <br />KITCHEN SINK 8 DISP <br />I <br />CLOTHES DRYERS <br />I <br />DISHWASHER <br />I <br />RANGE HOOD <br />G <br />LAUNDRY TRAY <br />I <br />WATER HEATER <br />1 <br />CLOTHES WASHER <br />0 <br />WOOD STOVE <br />�— <br />O <br />URINAL <br />O <br />METAL FIREPLACE (WOOD BURNING) <br />0 <br />DRINKING FOUNTAIN <br />Q <br />FIREPLACE INSERT (WOOD BURNING) <br />O <br />FLOOR DRAIN <br />I <br />GAS FIREPLACE <br />Q <br />BACKFLOW PREVENTERS <br />p <br />GAS RANGE <br />(>' <br />SINK(SERVICE — BAR, ETC.) <br />3 <br />GAS PIPING <br />_ <br />EXHAUSTFAN <br />SUBTOTAL f <br />SUBTOTAL t <br />PERMIT f <br />PERMIT f <br />;OTAL FEE t I <br />i <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK <br />MAY SETBACK <br />SIDE SETBACK <br />PLAN CHEC _N,1M�[Il, lj <br />fE �.�^ y <br />PECEIPi NO <br />PE\EI/ST <br />USE TONE <br />A <br />VACANT STE <br />V_•A'{LL/UAAJTION <br />FEE <br />— <br />❑"S O No <br />n0lmwf. <br />W UV-Z <br />U <br />�� <br />(J <br />IIEIOIIi <br />Els <br />VIATA11ON <br />WEWNG <br />SIZE OF BIp , <br />p <br />PIIIWMG <br />OCCUPANCY <br />GHWP <br />NJ (F EI(q(5 <br />2 <br />OCCUPANT l0A0 <br />BASEMENT <br />� <br />MECHANICAL <br />- <br />-3 v-I <br />❑YES v- <br />ADDITIONAL AANCHICK <br />- <br />M PgINKLEq gEO'0 <br />IIf ASCN -- <br />OTHER <br />fIREAUAM nCO'0 <br />REASOH <br />STAIEBIIADINGSIIPCHARGE <br />/ <br />rrrE of caln <br />riots APPTTovfD Dr CITY OF EVERETT <br />tool r. wonKs <br />-- <br />�_� <br />LOCAL SALES <br />6 14 TAX CODE IS 3105 <br />-- <br />_ <br />TOTAL <br />- <br />— <br />DATE <br />— <br />, <br />