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r. <br />� <br />APPLICATII..+I FOR COId�TRUC'�.ON PERMIT� <br />CITY OF EVERETT • BUILDING DIVISION <br />oN � 3200 CEDAR STREET • EVERETT, WA 98201 • 259•8010 <br />� -,e�•�� �- <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTADDRESS: � %�%- /,.P r�tf I� L1R �_ <br />-loNa�Glj��'kP� F �oG- s5`5`-R-S_"�/ <br />MARAODRESS C��/�}— lin PHOHE <br />� / S7� � �� /Jr /1' � �f �%G ` i'4'I i / ���� G � I ( � ( / � <br />7ENANT „� uMI.�ODftC55 (J f.i1Y 7i� <br />ARGHIT CTORDESIGNER M�It�bORESS Lltt 7�� ��10NE <br />GENERALCONfR�Gi0f1 M�II�DDf1E55 CIiV I�P PIIONE SfATELICENSEi <br />MECHANICAICONTRAGTOR MMI�DORE55 Cltt 21{` P110NE STATEUCENSE� <br />PLUTABWGCONTRACTOR M�ILADORE55 Lltt IIP PNONE STAiELICENSE� <br />DESCRIBE W AND 50 E F00 AC <br />— nv _ <br />/�.( ' /� Gv � <br />� <br />PROPOSEDUSE UILDINO <br />O/yJP (�� <br />LEGAL DESCRIPTION OF PROPERtt �SF <br />LOT � 9lOCN _ <br />8 7, 9/ � <br />G � �r' 4 <br />PNiCELTA%I.U. IUMBER <br />i�'7/�7-JoG, Oh� <br />CONSTRUGiIONLOAN DER,�UDRE' <br />e ri.� <br />�% <br />PLUMBIN6 <br />N0. TYPE OF Fl1(1 <br />WATER CLOSET (TOII <br />BATHTUB <br />LAVATORY (WASH BA <br />SHOWER <br />KITCHEN SINK 8 DISI <br />DISHWASHER <br />LAUNDRYTFAY <br />Cl0'.HES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />l Y�t a7L-2 ��f-d d � �� <br />a�vapve^o <br />YC'p5� _�Q�14 YfS <br />4 i f-�<S C�J <br />/ <br />BELOW OR �TTAGN 1W0 COPIES) <br />_ OF <br />� iyo F-� � <br />d /i� �,� 5 <br />�- Oh�OC� <br />TfIEPNOHE NUMOEfi <br />TING SYSTEM: � GAS ❑ ELECTRIC ❑ <br />�f P[t150N A PNOHE NO <br />IoN�C'r.'l�aF/���- <br />i H[REBY CEHTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORHECT ALL <br />PROVISIONS OF LAWS AND ORD�NANCES GOVERNING THIS TYPE OF <br />WOFlK WILL BE COMPLIED WITH WHETHEfl SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOFlITY TO VIOLATE OR CANCEI THE PROVISION OF ANY <br />OTHER STATE OR LOC4L LAW REGULATING CONSTRUCTION OF THE <br />PERFORMANCE OF CUNSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERN TO PkRFORM THE WORK FOR WHICH <br />APPLICATION IS MAOE AND I COMPIY WITH THE STATE <br />CONTFACTORS LAW 18.27 RCW AND 296200 WAC. <br />r���rj//�� �u/�w /G —/7'�'//—/ <br />SION/�TIPE � � � D�E _ / / <br />CITY pUSING55 LICENSE NO <br />FEE NO. TYPE OF EOUIPMENT FEE <br />� NC—A/HNDLGUNRS <br />� FORCEDAIR SYSTEMS <br />� HEAT PUMP <br />! UNIT HEATERS <br />� <br />SUB TOTAL S ; <br />PEFMIT S <br />TOTAL FEE S i <br />FOR OFFICE USE ONLY: <br />FRONTSETB�CN REAR SF.TOACN SIOE SETB�LK <br />USE20NE <br />HEIONT LIMITAf10N <br />OCWV�NCY N(10�51(NUFS <br />LOt�FEA <br />NO OFOWELUNO <br />UNIiS <br />UAtE <br />or <br />WATER HEATER <br />WOOOSTOVE <br />GAS FIREPL <br />GAS RAN�E <br />SUB TOTAL S ; <br />PERMIT S � <br />TOTAL FEE f ; <br />PUNf.IIELNNUMOfO I�EF IpECEIPTNO <br />V�CAN7 SIIE htt� <br />❑YES ❑ NO OUIl��NO <br />SIZE OF BLDGRI <br />PIUMOMG <br />B�SEMENi MFCnAML�I <br />❑YES ❑ NO <br />♦DD�IIONAI.(RANC��fCk � <br />Op�Bll <br />St�tE 011110ING SUnCHefIC.E <br />CITY OF EVERETT runi ic wonKs <br />LOCAL SALES ---- <br />TAX COD'�.'� `105 TOTnL <br />