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. FM�`-.'.'. <br />APPLICATIO� FOR CONSTRUCTrON PERMIT <br />CITY OF EV[RETT � BUII_DING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />I I DEMOLITION I� COMBINATION �AUILDING I 1 MECHANICAL i! PLUMBING f I SIGN <br />PROJECT ADDRESS <br />ownrn "Cho� j <br />i RCL i r> nl <br />Z7Z 1 I <br />MnIL nooRf SS <br />27Z i ( C �"< <br />MN�ApOR[55 <br />Sfl �f �- <br />anaarecronoesicr+en „ranu., <br />L,_, <br />—V <br />ceNen�� <br />� � rl � ���E % <br />cin z�r <br />�i. .��I���T i 9� �-c. <br />CILY 21P <br />urv zm <br />cirv zir <br />(ZD�,) ZS�,-3oL/ <br />PIIONE <br />FHONF <br />PHpNE ST�TE LIC@NSE v <br />�� L F <br />MECHNJIC�LCONiR�CTUR MAILADORE55 CIN ZIP PIIONE STATELICENSEd <br />PWl.1BING CONTP�CTOR �OFE55 Cltt ZIP PHOtlF STAiF LICEtlSE d <br />)ESCRIBE WOPK AND SOUARE FOOTAGE INVOhVEB <br />�rEa� D�F 4 L'�- ��c��lnlG i-40ME <br />�oo sc�, F � koti�E A��pr_�i—'x' z� s' <br />PfiOPOSED USE OF �WLDING <br />LEGAL OESCFIPTION OP PBOPERtt �SHOWN PELOW OR 4TTAC.H i WO COPIES) <br />LOT 13LOCK Of <br />PARCEITAXIO.NUMBER <br />CONSiRUCiION LO�N LENOEA. �DDRESS. TELEPI/ONE NIIM�ER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILFT) <br />9ATHTUB <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.) <br />FEE <br />. <br />� <br />i <br />� <br />SUB TOTAL 9 ; <br />PERMIT S <br />TOTALFEE S ; <br />FOR OFFICE USE ONLY: <br />FRONT SETFiFCK R[nR SET�ACK SIOE SETD�CK <br />USL 7.0Y[ <br />H[IGMT LRdITATION <br />OCCl1PANCV NO ( <br />enour <br />�or nr�en <br />NO.Of DWELLING <br />UNIiS <br />HEATING SYSTEM: f l GAS I � ELECTRIC f� <br />GUNTMT PERSON PND PIIONF N0. <br />I H[HEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION �ND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIOfJS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPEGPIED 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 CONSTRUCTIOtJ OR THE <br />PrRFORIdANCE 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 />CONTRA RS LAW 1P.27 R� A�9G.200 WAC.�/ <br />li y 7� �; � <br />X ,��,�� v �k'yl � L G'� 5 <br />SIGNAi11AF OAiF <br />CIiV �USINESS IICENSE N0. <br />NO. TYPE OF FIXTURE OR ITEVI <br />A!C —A/HNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT (WOOD BURNING) <br />GAS FIREPLACE <br />GASR�NGE _ <br />GAS PIPING <br />EXHAUSTFAN <br />vncnNr sire <br />i�vEs r�No om�mHc <br />SIZE OF ALDG/fl <br />nves n r+o <br />APPROVEGDV I CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PLUMI3MG <br />hlECH�NICAL <br />AUOIi10�`IPL PLAN CNECN <br />OTMGfl <br />ST�TE �UIL�ING SU�CMARGE <br />PUBI IC Y!O(iK$ <br />TOTAL <br />FEE <br />0 <br />SUB TOTAL S � <br />PERMIT 5 � <br />TOTALFEE S ' <br />FEE RECEIPTNO. <br />VALUATION FEE �_ <br />l,-�laC� _� /__ � �;c: <br />� <br />