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--. <br />APPLICATlO�V FO� CONSTRUC7.ON PERN6IT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STR[ET • EVERETT, WA 9P201 • 259-8810 <br />❑ DEAIIOLITION Cl COM4iINAT10N Il BUILDING �MECHANICAL rl PLUMBING fl SIGN <br />PROJECT ADDRcSS ., � i .-, _, � <br />owr+en <br />�. <br />PROPOSED USE OF BVILDING <br />LEGAL DESCRIPTION OF PflOPE <br />LOT BLOCK <br />CONSiPUCTIONLOAN <br />�ma <br />cm zir rNor�e <br />-�� ST Et% ��NoN�s�9� <br />citt zir /� r�iove <br />i � � C � �� �f /�� ����7�7 <br />cirv zir ruoNe srnte <br />MFILADOPESS l:nY <br />htAI��ORESS CIT1 <br />� <br />� <br />!�-6% " <br />vr,E irvvo� <br />�; cr/��lc` <br />O/!/A-c �— <br />� ISHOWN BELOW OR ATiACH TWO C�PIES) <br />TELEPHONENUMBER <br />PLUM8ING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISF <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHEf; <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — DAR. ETC.) <br />SUBTOTAL 5 <br />PERMIT 5 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FPONTSEiBACH REAP SETBACK <br />USEZONE LOTPREA <br />HEIGHTLIMITATION NO.OF�WEWNG <br />UNIT$ <br />OCCUPANCV NOAFSi0RIE5 OCCUPANTIOAD <br />REASON <br />PEASON <br />BY <br />"/U32�.. <br />YIIVNL JINI[LI@NSt1 <br />PHONE ST�TE LICENSE x <br />HEATING SYSTEM: GT"GAS ❑ ELECTRIC ❑ <br />CONU�CT FERSON PN� PHONE N0. <br />�� —.� ; -,– 4 ,r ., n , ,1 �-, � _ SY. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORP.ECT. ALL <br />PROVISIONS OF LAWS AND O?.DINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WIiH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUt��c TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING COIJSTRUCTION OR THE <br />PEAFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERT PERFORM THE WORK FOR WHICH <br />APPLICAT N I� D D I COMPLY WITH THE STATE <br />CON CTORS .27 W AND 296.200 WAC. <br />/�z2� <br />X <br />�� OATE <br />CITY BUSINESS LICENSE NO. <br />FEE NO. TYPE OF FIXTURE OR ITEM <br />i A/C —AMNDIG UNITS — H.P. <br />—� <br />� FORCED AIR SYSTEMS — B.T.U. M E.A. <br />—� HEAT PUMP <br />� UNIT HEATERS — B.T.U. M <br />i CLOTHES DRYERS <br />�— VENTILATION FAN <br />� RANGEHOOD <br />WATER HEATER <br />� WOODSTOVE <br />i AIETAL FIREPIACE (WOOD BURNING) <br />� FIREPLACE INSERT (WOOD BURNING) <br />; GAS FIREPLACE <br />� GAS RANGE <br />� � GAS PIPING <br />� EXHAUST FAN <br />SIOE SETBACK <br />VACANT $ITE <br />O <br />i <br />� <br />SUBTOTAL S <br />PERMIT 3 <br />TOTAL FEE 5 <br />PLANp1ECK�lUM�FR�-� FEE —IRECEIPTNO. <br />�/G �� 7:�' <br />fJ YES n N OUILDING <br />SIZE OF BLDGRA. <br />PWM�IqG <br />BASEMENT MECMANICAL <br />❑YE$ fl NO <br />ADOIT70NAL PLAN CHECK <br />OTHER <br />STATE BUIL�ING SURCNARGE <br />CITY OF EVERETT ruoucwonres <br />LOCAL SALES <br />TAX CODE IS 3105 TO7aL <br />