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APPLICQTI�..i FOR C�NSTRUCi _JRO PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETi, WA 98201 • 259-8810 <br />❑ DEMOLITIQN fl COMBINATION rl BUILDING �'f MECHANICAL � PLUINBING fl SIGN <br />S� �. C'��`� �I�S � Sl- i�I;�cK-�� �icl,�i <br />TENANT MNLA DRE� SS Cllv ZIP PNONE <br />PWMBINGCONiRACTOR MAIL��DRESS GI7Y ZIP PHONE STATELICENSE/ <br />DESCRI9F <br />PROPOSED USE OF BUILDING <br />LEGAL DESCFIPTION OF PROPEflTY �SNOWN BELOY! <br />LOT �LOCN OF_ <br />��Q � ��� l �� <br />IOPIlLENOER,ADDRESS,TELEPHONE 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 />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.1 <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE $ <br />FOR OFFICE USE ONL�: <br />FPONTSETAACK REAF SETOACK <br />USEZONE LOTAREA <br />HEIGNTLIMITATION NO.OFDWELLING <br />UNIT$ <br />OCWPANCV NO.OFSTORIES OCCUPANTLOA� <br />GROUP <br />FIRE SPRINNLER FEO'0 REASON <br />TVPE OP CONST. PlANS A <br />DATE <br />FEE <br />SI�E SETOFCK <br />VACANTSITE <br />IlYES fl NO <br />HEATING SYSTEM: y','GAS ❑ ELECTRIC ❑ <br />CONTACT PERSON ANO PNONE NO� .. _ <br />I fiEREBY 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 />WOHK 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 LO L LAW REGULATI TRUCTION OR THE <br />PEiiFORM�h1�E () STRUCTION. T T I AM UTHO�ED 81' THE <br />OWNEH'C)F �TH ERTY�O'B FORM T WJdf�K�FOR WHICH <br />APPLfCAI l0 �D'� AND� I COMP ,YliTb(/ THE STATE <br />CITY <br />N0. TYPE OF FIXTURE OA ITEM <br />A/C—A/HNDLGUNITS—H.P. ` <br />FORCEDAIRSYSTEMS—B.T.USSfv1 E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHO00 <br />WkTEF HGATER <br />WOOD STOVe <br />METAL FIREPLACE (WOUD BURNING) <br />FIREPLACE INSERT (WOOD DURNING) <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />PLAN <br />ONL�ING <br />512E OF BLIX'i/CL �� --- <br />PWMpING <br />9ASEkENI MECN�NIC�L <br />�]VES fl NO <br />ADDITIONAI PLpN CHECK <br />OTHER <br />STATE BUIlDIN3 SURGHARGE <br />CITY OF EVERETT rue ^wonrcs <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL S <br />PEFMIT 5 <br />TOTALFEE S <br />FEE � RECEIPTNO. <br />FEE <br />