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APPLICATIG.J FOR GONS�RUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL Tj� PLUMBING CI SIGN <br />PROJECT ADDRESS <br />OWNEq <br />� <br />MAIL ADORE55 <br />[� <br />�J-�t (' /�Q,L �� <br />- . <br />CITY fi �IP <br />I(�� I I r U Ca,' I� <br />dTV 21P <br />ARCHRECTOR�ESIGNER MAILADORESS CITY 21P PHONE <br />GENERAICONTRACTOR MAILA��RE55 CITY ZIP PHONG STATEUCENSEN <br />PW MBING CONTIIACTOR <br />LEGAL DESCFII TION OF PROPF <br />�or _ _ o�ocK <br />CONSTRUCTIONLOANLENUER,ADORESS,TELEPHONENUMBER <br />NO. I TYPE OF FIXTURE OR ITEM <br />BATHTUB <br />LAVATORY(WASH BA: <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ET <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAI FEE S <br />G <br />FJR OFFICE USE ONLY: <br />FROM SETBACK RE�R SETB�CK SI�E SF.TBACK <br />USEZONE <br />HEIGHT IIMITFTION <br />LOTAREA <br />NU. OF �WELLING <br />UNITS <br />OCCUPANTLOA� <br />CIiV <br />ZIP P�IONE STATE LICENSE Y <br />PHONE STATE UCENSE Y <br />HEATING SYSTEM: ❑ GAS ❑ ELEC7RIC ❑ <br />I HEREBY 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 />WORK 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 LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PER�ORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />X Z-�,�i`� <br />SIGNpTURE �ATE <br />CITV BUS��S LIC NSE N0. <br />FEE NO. TYPE OF FIXTURE OR ITEM FEE <br />� A/C—A/HNDLGUNITS—H.P. <br />; FORCED AIR SYSI :_MS — B.T.U. M E.A. <br />� HEAT PUMP <br />' UNIT HEATERS — B.T.U. M <br />i CLOTHES DRYERS <br />RANGEHOOD <br />WATEF HEATER <br />METAL FIREPLACE I <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />EXHAUST FAN <br />SUBTOTAL S <br />PERMIT S <br />TOTtiL FEE 5 <br />PLANCHECKNUM�ER/� I FEE � FECEIPTNO. <br />VACANT SITE FEES <br />f7YES ❑ NO pUILU1NG <br />SIZE OF BLDGRI. <br />PLpMBING <br />BASEMENT MECHANICAL <br />❑VES fl NO <br />A��ITIONAL PLAN CHECK <br />OTHER <br />STATE OUILOING SI1qCHAfiGE <br />CITY OF EVFRETT ruaucwoaKs <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />