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ApPLIGATIa.� FOR CONSTRIJCT, JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STFEET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION � COMBINAYION ❑ BUILDIP'G ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRE$S: �OO �✓C�.����hJ �Y �� � ��/�� �;� ,x,,�,� <br />GITY ZIP PIIONE <br />�6 hvvrce Ad, �' �87.c�/ �4�s) 2sz-�8'48 <br />. un zm PIIONE ,, n . <br />GENEflAL CONTfl TOq � MAIL /�OOBESS CIIY ZIP PIIONE SIATE IICENSE • <br />�'UR1��'� S�i�fi1-l�lf1'C- <br />MECHLN�C�LCONTRACiOR MAILAODRE55 LITY IIP PIIONE STATELICENSE <br />PLIlMe1NGCONTRl1�iDB M�ILADDRESS CIN Z�P PIIONE STATELICENSE� <br />CONTMLT PRICE OF WORK <br />DESCpIBE WORN AND SOU�RE <br />% �� SO/��. <br />� � <br />S ✓C� <br />PROPOSED USE OF BUILDIN6 <br />LEWL OESCRIP(ION OF PROPI <br />LOT 9LOCN <br />CONSiRIK170N IO�N LENOER. �DDaE55. TELEPHONE Nl1MBER <br />PLUMB�NG <br />NO. TYPE OF FlXTURE OR ITEM FEE <br />WATER CLOSET (TOILE'n <br />BATHTUD <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL 3 <br />PERMIT S <br />FOR OFFICE USE ONLY: <br />FRONTSE78ACN REARSETBACK <br />�� v <br />USEZONF� <br />�� <br />NEIGIIT UMITATION <br />OGGUPANCY ND ( <br />Gf10UP <br />FIR � PINIHLEfl NEi <br />M� <br />FIREAV �M REO'D <br />�� <br />TYPE OF f,ONST <br />1 �... 1 �_ <br />LOT AREA <br />NO OL OWELLING <br />UNII$ <br />[KCUPANT �OAO <br />. 1, <br />RF.PSON <br />REASON <br />PLANSA l�OVEDOY <br />�� <br />�..� S -tiI' <br />SI�E SET6ACN <br />U <br />vncu+r srte , <br />HEATING SYSTEM: � GAS ❑ ELECTRIC ❑ <br />GONTAGT PERSON AND PMONE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO Ee TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OF CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEiiFORMANCE OF CONSTqUCTION. 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 />CONTRACTO W 1827 RC AND 296.200 WAC. <br />" s <br />SIGNATIIR DATE <br />CITY 6USINESS LICENSE N0. <br />MECHANICAL <br />��n TVDFflFF/.'IIPMENT FEE <br />A/C—AMNDLG U� <br />FORCED AIR SYSTI <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />MEfAL FIREPLACE i <br />FIREPIACE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />SUB TOTAL 3 <br />PERMIT 5 <br />TOTAL FEE E <br />PUNCIIECKNUTABEII FEP ���I�ECEIPTND <br />OYE$ NO OUILO�NG <br />SRE OF BLOGR.I <br />"7 / _ D PLUTAOING <br />I ll1 <br />BASEMENT MEC�UNIC�L <br />❑YES NO <br />R�DI710NA1 PUN C��F.CK <br />071/ER <br />STATE BIIR�ING SIIRCIIARGE <br />CITY OF EVERETT rumir.woans <br />-f LOCALSALES <br />iL TA% CODE IS 3105 707AL <br />7 <br />