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APPLICATIO.FOR CONSTRUCTI jN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />32GD CEDAR STREET E EVERETT, WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: ?/gyp /iEWCYT A4yE E✓�?EJT WA. <br />OWNER MAIL ADDRESS Cm tlr PHONE <br />QO%jE/Z> /Nr?r#o�/ a6���/Ic�c.YvE THco.�n ��yQ� <�ae) a71-S �fo3 <br />MONT MAIL ADDRESS CITY 71P P"OHE <br />r csFk /�d'oaAP 1��6 3�`LA✓E �o�z>s.w. TAGoiETA 9RLf99 �ao6�" z-S"�v7 <br />ARCHITECT OR DESIGNER IAAK ADDRESS cm lip M1oNF A i✓ >✓ ��O <br />1 GeOl..ct-� r_...n.i�>.» 5 .261/ pAirftc A✓E ?ALOM,v #—A_ (.2Or/ <br />nr , AQ/ MIONE I STATE LICENSE H <br />ME= COIETMCTOR MAAADDRESS CITY IIP � PIIGNE STATE LICENSEE <br />AWIFLAP✓ <br />KIMN6 CONTMC70R MAN ADDRESS Lltt IIP PHONE STATE LICENSEE <br />r <br />caHTRAcr PRICE OF wart <br />30 o buzz <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AM SOLAARI FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />T StA aN7 7 S 7 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />PR POKOUW OF BUILDING <br />RI5S7 / 7 <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LAOX0EsdwroNOFPROPERTY (SHOWN BELOW OnATTACH TWO COPIES) <br />1-2 BLOCK 69 y OF S NA <br />7 <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />LOT <br />CITHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIM BY THE <br />AODCTLOh/ <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WINCH <br />APPLICATION IS MADE AND l COMPLY WITH THE STATE <br />CONTTRRAACCTORRS- LAW 18.227,RCC,W AND 288.2W WAC. <br />Prim TDL I.D. NUVAM <br />3 D N <br />COMTIILIC110N LOAM 1E11GER, ADDRESS. TilfPH10HE MAlER <br />SIONAT IIIATE <br />RTt G H!A✓ ✓coo S <br />L WAX1+i <br />CITY TILISIINESS LICENSE NO <br />PUMMq <br />MECHANICAL <br />NO. TYPE OF EOUNIM INT FEE <br />NO. <br />TYPE OF FIXTURE Go TREM <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />MC — A444OLO UNITS <br />' <br />SAT TLE <br />' <br />FORCED MR SYSTEMS <br />LAVATDRY (WASH BASIN) <br />, <br />HEAT PUMP <br />' <br />SHOWER <br />UNIT HEATERS <br />' <br />KITCHEN SM A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNORYTRAY <br />) <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DFSNKING FOUNTAIN <br />FIREPLACE UNSEAT (WOOD BURNING) <br />DRAIN <br />GAS FIREPLACE <br />' <br />FLOOR <br />BACKFLOW PREVENTERS <br />i <br />GAS RANGE <br />' <br />SINK (SERVICE — BAR. ETC.) <br />GAS PMTM(G <br />EXHAUSTFAN <br />, <br />1 <br />i <br />, <br />SUB TOTAL f <br />' <br />_SLAB TOTAL f <br />PERMIT f <br />r <br />PERMIT f <br />' <br />TOTALFEE f <br />' <br />TOTAL FEE f <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETSAat / I HEART <br />use ZOO? <br />HEIGHT LHW TAT ON <br />FIRE <br />-" I hK- <br />101ARIA U <br />NO OF DwELLINO <br />('"Im <br />SIDE SETBACK IPIANCIECR <br />VACANT SITF <br />SUE OF <br />❑YES ❑ NO <br />MAIT11Nf <br />BIDD/TI <br />L)� <br />rAlrMpn.r, <br />MFr.NAMf.N <br />\SELENT <br />DYF5 Mbb w) <br />�- <br />ADfA1R1NA1 MAN CI1r CK <br />01111,01 <br />SIA1E plAl DINT. 511ISI11AIXIf <br />rupl ¢ w A1K5 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />FEF _ _ .. �12 RECrIPT NO <br />