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APPLICI�,T11.�1 FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVER�TT, WA 98201 • 259•8810 <br />i l DEMOUTION rl COMBINATION �-FJi11LDING OtMfCHANICAL "►�PL:tMB�NG rl SIGN <br />PROJECT ADDRESS yO � � ����D�/-��-`C I <br />t <br />� �r� MAILFDDR[55 /YY Qtt ZIP /�� PqMO4E <br />�� V� �i 3 i l O'P�J O/-E �Vt �% �E/a."nL�G. -1 V 1 i7 � <br />PI/ONF: <br />`t!o �- S�11 <br />S a- �..n � <br />GENERALCONTRA.IOR MRILADURE55 CITV ZiP PNONE STATELIC[NSEx <br />�A. M a7. <br />f�q MAllA0DRE55 <br />� b�� <br />YlORK <br />WORN ANO SUUARE FOOT�GE INVO WED <br />(:��--� <br />PRO/P� E F BUILD:Np <br />L/ 1 G� � <br />LEGAL OESCRIPTION OF PROPE <br />LOT OLOCK <br />PARCELTA%IO.NUMBER <br />OMn <br />LEEu1Y.0O }—� <br />CONSTRUGTION IOAN LENDER. ADDPE55, TEIEPHONE NUNBEP. <br />NO. TYPE OF Fl%TUFE OP <br />� WATER CLOSET (TOILET) <br />BATHTUB <br />KITCHEN SINK 8 DISP <br />OISHWASHER <br />LAUNDFlY TRAY <br />CLOTHES WASHER <br />UPINAL <br />DRINKING FOUNTAIN <br />FLOOR �RAIN <br />BACKFLOW PREVENTE <br />SINK ISERVICE — BAR. <br />SUBTOTAL S <br />PERMIT S <br />TOTALFEE S <br />cnr <br />FEE <br />FOR OFFICE USE ONLY: <br />FRCNTSETBACR �EO.R SETBACK SID[SETBACK <br />UGE 20NE <br />HEIGIIT LIMIIATION <br />OCCUPANCY NOAi <br />GROUP ' <br />FIRE ALARM R�O D <br />No <br />FlRE SPRINKLEfl REI <br />N� <br />nae a� coNsr <br />.� <br />IOTAREA <br />NO. OF OWELLING <br />U1:ITS <br />OCCUPANTIORD <br />� <br />VACANT SITE <br />IIYES fl NO <br />SRE OF 6LOGRt. <br />rnune <br />� <br />u� rr�v..c „��� � ��S-• <br />� � "'•� � <br />., <br />HEATING SYSTEM: AS 17 ELECTRIC ❑ <br />CO GRSONANDPNONENO <br />�A��e-�-L �•,..fG-�e� "l��-5"1�2. <br />�j'{gvvi.s �jYoc�i..6 -1 b 8 -5T O� <br />I HEREBY CERTIFY THAT I Fi.�VE READ AND EXAM�NED 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 OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LQCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT i AM AUTHORIZED BY THE <br />OWNFR OF THIS FROPERTY TO PERFORM THE WURK FOR WHICH <br />APPLICATION I ADE AtJD I COMPLY WITH THE STATE <br />CONTRAC 0 LAW 1 7�RC0�7lA 6.200 WAC. <br />�� y �- ys -, <br />x OA7E <br />SIGNATURE <br />CITV BUSINESS LICENSE N0. <br />NO. TYPE OF FIRTURE OR ITEM _ � FEE <br />A/C — AMNDLG UNITS — H.P. <br />FORCED AIH SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD E <br />FIREPLACE INSERT (WOOD <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING _ <br />EXHAUST FAN <br />SUO TOTAL S <br />PERMIT 5 <br />TOTALFEC $ <br />FEE � NECEIPT N0. <br />OmLDINa P% 1. 49/� ` I L G 7 i— <br />/ � PLUTABING <br />7 <br />MENT MECHANICAL <br />❑YES �CNO <br />ADDITIONAL PUN CHECK <br />I OTNER <br />CITY OF EVERETT �'UBIIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />