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APPLICATIt.N FOR CONSTRUCT mON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259.8810 ff <br /> SS <br /> f 1 DEMOLITION 11 COMBINATION I I BUILDING <br /> MECHANICAL I I PLUMBING I i SIGN <br /> PROJECT ADDRE <br /> V, 1 - = C <br /> OWNFR MAIL ADDnFSBU <br /> CIT" lIr "TION[ <br /> m 111 IAM y <br /> i IL FY L. MI ADGnF55 L� <br /> \N�� MCiv 71P PHONE a-7_' <br /> ,HPIECT OR DESIGNER MAIL ADDRESS CITY <br /> PP PHONF <br /> GENERAL CIXiMACTENT MAIL ADnnE55 CITY <br /> 71P rllONf. STATE IICENSF A <br /> MFCNANI�CONTRACTOR MAIL ADnnESS CITY 71P <br /> —P''ON' STATE LICENSE 1 <br /> Pl11MLIIN6 CONTRArtOR MAIL ADDRESS <br /> CITY <br /> ZIP rIIONE STATE LICENSE/ <br /> CONTRACT PRICE OF 1YO11R <br /> HEATING SYSTEM:. GAS I I ELECTRIC I I <br /> f)ESCRIBE NORk ANOTARE FOOTAGE INVIXVED <br /> _ CONTACT PERSON AND PHONF NO <br /> E �N <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OFRIMIENNG APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL DESCmPTION OF"ROPEF Y IS'A51VNBELOWOR ATTACH IWO Cor,F , WORK WILL DE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> Lot BLOCk or 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 /> APPLICATIO IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAM I D NUMSER CO <br /> RS LAW 18.2 R W AND 298.200 WAC. <br /> CONSTRUCTION LOAN LENDER,ADENTESS.IEIEPMNJNE NVMBER <br /> X S <br /> SIG TURF DAT <br /> COY BUSINESS LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) I A/C—AMNDLO UNITS—H.P. I <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) I HEAT PUMP <br /> SHOWER <br /> ' UNIT HEATERS—B.T.U. M I <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS <br /> DISHWASHER <br /> ' VENTILATION FAN <br /> LAUNDRY TRAY I ' <br /> CLOTHES WASHER i RANGE HOOD <br /> WATER HEATER <br /> URINAL ' WOOD STOVE I <br /> DRINKING FOUNTAIN I METAL FIREPLACE(WOOD BURNING) <br /> FLOOR DRAIN I FIREPLACE INSERT(WOOD BURNING) 1 <br /> BACKFLOW PREVENTERS � GAS FIREPLACE 1 <br /> SINK(SERVICE—BAR,ETC.) I GAS RANGE <br /> 1 <br /> ' GAS PIPING I <br /> EXHAUST FAN <br /> 1 1 � <br /> � 1 <br /> I <br /> I <br /> SUB TOTAL S ' <br /> PERMIT S SUBTOTAL $ <br /> ' PERMIT $ I <br /> TOTAL FEE S ' TOTAL FEE S I <br /> FOR OFFICE USE ONLY: <br /> FnCNT SFTBACk nrAn SFTBACk SIDE SETRACk PLANCIIE7NUMBFR fEE nFCFInT NO <br /> USE TONE IOTAFIFA VACANT SRF FEES VALUATION FEE <br /> I iYFS NO <br /> BUILDING <br /> HEIGHT LIMITATION NO OF DWELLING S17E Or B:DGRI <br /> TWITS <br /> PLUMBING <br /> OCCIIPAN[:Y NO 01 SIPni18 OCCUPANI LOAU BASEMENT <br /> CRIXIP MECHANICAL <br /> IIYES 11 NO <br /> FIREALARM 100 RFASON ADENUONAt PI AN CHECk <br /> PInF S"WNMI—Fn REOn RFASON OTHER <br /> STATE 01111DING SIIFICHARGE <br /> TYPE or roNSt PL ANS APPPOVE00Y CITY OF EVERETT Punnc WGnkS ' <br /> LOCAL SALES <br /> DATE TAX CODE IS 3105 TOTAL <br />