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� <br />APPLICAT10.1 FOR CONSTRUCT. JN PERMIT/ <br />CITY OF EVERETT • BUILDING DIVISION {!C� <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 � <br />❑ DEMOLITION ❑ COMBINATION � BUILDING O MECHANICAL ❑ PLUMBING p SIGN <br />PROJECTAODRESS:=JZIS 13�Z�+1-DrJ/N�j �V�� �R �jE�p; <br />MNL 11ppr1E55 <br />pTr IIP qqNE <br />� 58u3 3ss �� <br />�NLMTCCTORpESIGNER MI11LI10DnE55 CiTY ZIP PNOHE <br />�.EMEWIL�ONTR�GiOR MAILADO{IE55 G7Y 11f` pIIONE $iAiGUCFNSE� <br />� <br />�oT <br />M�I� <br />MIORK 11ND SOU�RE FOOT�fsE <br />a rnopi <br />_ BLOLK <br />.:.. <br />CONSTRIILTqN LOlW LENOEq, w�r`F55, TELEP110NE NUMBER <br />r�ureiNo <br />NO. TYPE OF FlIfTUqE OR ITEM fEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />UUNDRY TRAY <br />CLOiHES WASHER <br />URINAL <br />DRINKIN(i FOUNTAIN <br />BACKFLOW PREVENTEiiS <br />SINK (SERVICE — BAR. ET <br />SUB TOTAL f <br />PERMIT S <br />FOR OFFICE USE ONLY: <br />i110NTSET9l1CN PEARSET811LK SI�SFiBACN <br />'LD � S .S � /O . <br />USE ZONE l07 APEA yA��Nf SItE <br />—� �L O 770 'F ❑res �No <br />MEIGNT LIMITATION NO OF OWELUNp 512E OF BlO6R.1 <br />Z � UNIfS / <br />DO <br />GCCUPIINCY NO 0� SI(%tlF5 OCCUPA_N/� IOAU B�SEMENT � / <br />�J � /V � ❑YES �NO <br />tiU <br />MARM REO'D <br />N� <br />•� � � ,^1'•�u�mnr CITYOFEVERETT <br />V� _ / /J'/�� LOCAL SALES <br />�V D�TE fn - i N-^t l, TAX CODE IS 3105 <br />HEATING SYSTEM: O GAS ❑ ELECTRIC ❑ <br />CONT�CT PCHSON �ND PNOHE Np <br />5� E�sT�n� ass-i�rN <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CARRECT ALL <br />PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOCAL LAW REGUUTINp CONSTRUCT�ON Oq THE <br />PERFORMANCE OF CONSiRUCTION. THAT 1 AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK WR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW iB27 RCW AND 296200 WAC. <br />x `Y�'j I� �-ZG-9G <br />SIGII�TtIf� DI1TE <br />V <br />CITY BUSINE55 L10EN5[ NO. <br />TYPE OF ECU <br />A/C — AMNDLG UNRS <br />FORCED AIR SYSTEMS <br />NEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />PANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />GAS PIPING <br />A�AN CIIEGN NUMBCR <br />em�on+� <br />rwumNc <br />MELMNlIL�L <br />�DDIIION�L PLAN C�1CGR <br />omen <br />STAIB BWl01NC SIIRCHARCE <br />f'lIBI1f, WORNi <br />TOTAL <br />SUB TOTAL f <br />P[RMIT S <br />TOTAL FEE f <br />(EF /O RECFIPTNO <br />� � <br />VALUATION I <br />ilo a90 ir <br />'_aJ <br />