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�►RPLICATIOI�e Fai�t CONSiRUCTIVN PdRMlT <br />CITY OF EVERETT • BUILDIiJG DIVISION <br />3200 CEDAP STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION O COMBINATION ��7 BUILDING ❑ MECHANICAL ❑ PLUMBING C] SIGN <br />J � <br />7EN�NT MRIlA00RE55 CITY ZIP PMONE <br />ARCHITECTORDESIGNER MRII/�UDRE55 CIlY Zi� n11pNE <br />PUIMBINGCONTRRCTOR MpILADORE55 G1Y ZIP PIIONE STATELIGE .c� <br />LEGAL <br />LOT _ <br />PRICE OF WORK <br />BLOCN <br />INVOIVED <br />(SHOWN BELOW Oq A7TACN TWO COPIES) <br />CONSTRUCTION LO/.N �EN�ER. ADORESS. TELEPMONE NUTABER <br />NO. � TYPE OF FIXTURE <br />—�ATER CLOSET (TOILET) <br />LAVATORY <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN' <br />CINK ISFRVICF — RA <br />FOR OFFICE USE ONLY: <br />FRONTSFT��CN AEAP $ETBACK <br />USEZONE <br />MEIGMi LIIAITATION <br />OCCUPANCY11q Oi5 <br />G{iOUP <br />FlRE SPRINKLEfl RE�'D <br />IOT�REA <br />fEE <br />0 <br />SUB TOTAL 5 ; <br />PERMIT 5 � <br />TOTAL FEE S ' <br />90E SETBACN <br />NO.OFDWELUNG <br />UNIfC <br />ORTE <br />IOAD <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTRL� PERSON AND PHO"E N0. <br />I HEREBY CERTIFY THAT I iIAVE 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 OF7 <br />NOT. THE GRANTING OF A PERMIT DOES NOT PAESUME TU GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION JF ANY <br />OTHER SiATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOfiIZED BY 7HE <br />OWNEF OF T S PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATI �IS MADE AND I CO�y1�LY WITH THE STATE <br />CONTRA O LAW 18.27 FCW AND 29ff D WAC. <br />CIN BUSINESS <br />N0. <br />NO. TYPE OF EOU <br />,VC — AMNDLG UNRS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORYERS <br />WATER HEATE <br />WOOD STOVE <br />MEfAL FIREPL <br />DCIiAUST <br />V�CANT SITE �cC� <br />❑YES ❑ NO OUIIDING <br />SIZE OF BLDGRI <br />PLUMOING <br />9ASEIAENI u[L11nNIC�L <br />❑YES ❑ NO <br />PD�171G'i.l PLAN CIIF.:N <br />OTHER <br />STPTE OWlO���G SIIRGHARGE <br />CITYOFEVERETT rueiicwoeKs <br />9� LOCALSALES <br />TAX CODE IS 3105 TO7AL <br />!EE <br />S1B-TO�TAL S <br />PERMIT S <br />T07ALFEE $ <br />RECEI°! NO <br />FEE <br />