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APPLICATIO�. FOR COI�STRUCTI.�N PERMIT� <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98207 • 259-8810 <br />❑ DEMOLITION [J COMBINATION O BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PRWECTADORESS: %D O� C_r, L%�c. <br />��o� 75.3-3 <br />Sa.^.,� <br />TENANT 4N1�00RE55 L17Y Z�P PHONE <br />11RCr1ITECTOR0E51GNER MARI100qE55 CITY 7m PMONE <br />(.'�NERYGONTR��Tdi MAIL�DORESS [ITY 7iP PnONE SGIEIIGfNSE� <br />ni �r� � <br />4ECN11NIG/�1C0�1TR�GTOii M�IIADpi1ES5 CI7Y ZIP PIIDNE $t�TELiCEN$E/ <br />PIUYBMGCONTR�QOii MRII�DORE55 GtY IIP PHpNE STAIEL�CENSE� <br />COMTMCT WMCE OF YA11N <br />�NO $IXJ�IIE FODTKsE N1VOlVED <br />raoroseo use ov mmdr+a `_ +_ r,'�1 <br />�\ <br />IEGM.0E5CR1PTlpf OF PROPERTY ISNOWM bElOw ORl1TT/�CN TYND COFIE51 <br />�ot e�oac aF <br />PAIICEL T/J(1 O. MIMBER <br />MSTiN1CT10N 101W LEN�ER. A00f1E55, TELE{`110NE NUA1BEq <br />PLUMISINO <br />NO. TYPE OF FlXTURE OR ITEM FEE <br />WATER CIOSET (TOILET) <br />BATHTUB <br />UVATO(iV (WASH BASIN) <br />SFIOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />IAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SUB TOTAL f <br />PEiiMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />iRONT SETBACI( RE�R £F.TB�LN SI�E SETB�CN <br />usexor+e ILOT�RE� <br />HEIGNT UMITIITION NO OF DWELUNO <br />UNII[ <br />OCCVP�NGY NO Of S�Ou�ES OGCUPANT 10�U <br />REO'D <br />HEATING SYSTEM: ❑ GAS� ❑ ELECTRIC ❑ <br />CONI�GT P[RSON �MD PNONE NO <br />1 HEREBY CERTIFY THAT 1 HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW TFIE SAME TO BE TRUE AND CORRECT ALL <br />PHOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL 8E COMPLIED WITH WHETHER SPECIfIED HEREIN OR <br />NOT. TII[ 6RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGUUTIN6 CANSTRUCTION OR TME <br />PERFORMANCE OF CONSTFUCTION. THAT I AM AUTHORIZED BY TNE <br />OWNER OF THIS PROPEHTV TO PERFORM THE WORK FOR WHICFi <br />APPLICATION IS MAOE AND I CCMPLY WITH THE STATI: <br />CONTRACT RS LAW 1827 RCW AND 296.200�f C. <br />x 'CG.,/�N // .i1 `/.f� <br />�IG URE � D�tE <br />CIiY 6VSINE55lIC[NSE NO <br />MECHANICAL <br />NO. TVPE OF EQUIPMENT FEfS <br />FQRCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT I1EA7ERS <br />WOOD STOVE <br />FIR[PIACE I <br />GAS FIREPU <br />GASRANGE <br />SUBTOTAL S � �_ <br />PERMIT S � <br />nur+c�iecK r+uw+En I rrE I�r.Emr No <br />sS90✓ <br />WCIINT SIIE <br />❑YES ❑ NO OWIDINC <br />5�2E OF BL06rtI <br />Pt11M01NG <br />BASEMENT MECIUNICM <br />❑YES ONO <br />HF�SON PDDII IpNII. M. �N Cllf GN <br />oinrn <br />REAFON — <br />S1�1C OUII�i�+G SIIt1Cluqf.E <br />D�TE <br />CITY OF EVERETT rimnr. woaes <br />LOCAL SALES <br />TAX CODE IS 3105 TOia� <br />�!I <br />