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APPLICATIG.i FOR CONSTRUC7.JN PERMIT <br />CITY OF EVERE i T• BUILDING DIVISION � <br />3200 CEDAR STFiEET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION I-1 COMBINATION � BUILDING (7 MECHANICAL 17 PLUMBING f� SIGN <br />FROJECT ADDRESS <br />pyJryEq MMLADDRESS CITY ZIP PMOYE <br />ao�c�s � ����Y `/IY ���rSy F�f,���T ��Z-�o4� <br />7ENANT MRILRDDRESS dtt ZIP PIIONE <br />�RCHITECTOR�ESIGNER MMIADDRE55 GITY 21A <br />GENENRLCONTR�CiOR MAILADDRESS Citt 7.IP PHONE StAiELICENSE� <br />NA�6 LNNS � � r;i lr� cm-� �� c��i';r- �e,.�� L.S�-iYSO Nnc�-rc� Z3�°ti <br />uccusulf.�l CONTRRCTOR MAIU��ESS CItV ZIP PHONE STATELICEt15E♦ <br />VLUMBINO CONTR�CTOii MAIL ADDPESS CIN ZIP �NONE STATE LILENSE � <br />CONTR�CT PRIGE Of WOFK <br />�IiJo' <br />DESCRIBE V/ORK AND SOURRE FOOTAGE <br />R�1/firlrL d✓��-�-�p <br />G����, da��r." Nar Rr <br />PROPOSEO VSE OF BUILDING �7 <br />/�r .f(�'L�i'G�' <br />LEGALDESGRIPTION OF OPE SHOWN BEL W O <br />i 1 �+". `.�- t� � t <br />LOT � �f 1� � BLOCK OF_ <br />t3tn4� (�S Pr�� y R�. <br />iW0 COPIES) <br />� <br />c <br />ik <br />1- rt lkoAif �11✓ <br />PAPCELTA%IO.NUMBER <br />553� r7S ot� otic3 <br />CONSiRUGTON LO�N LENOEN, �DDRE55, TELEPHONE NUMBEfl <br />TVPE OF FlXTURE OR ITEM <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TPAY <br />CLOTHES WASHER <br />URINAL <br />DRINKIN(3 FOUNTAIN <br />FlOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ETC.) <br />SUB TOTAL <br />�— _ TOTAL <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK RE��TB��� <br />��� <br />USE20Nfj� � LOTAREA <br />IIEIGIII LIMR�TION I UNi Sf OWELLING <br />NO OF <br />$ <br />$ <br />HEATING SYSTEM: Cl GAS ❑ ELECTRIC ❑ <br />CONTFCT PERSON PNO PNONE N0. <br />�� z� i yS° — <br />I HEREOY CEHTIFY THAT I HAVE READ AND EXAMINED TH75 <br />APPLICATION AND KNOW THE SAME TO BE TAUE 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 />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER S?ATE OR LOCAL LAW REGULATING CONSTRUCTIDN OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEHTY TO PERFORM THE WORK FOR WHICM <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />i <br />�� 1� � 3— � z.,9r <br />X DI.TE <br />SIGNPTVIIE <br />CITY BUSINE55 L!CENSE N0. % S <br />�E Np, TVPE OF FlXTURE OR ITEM �E <br />� p/C —A/HNDLG UNITS — H.P. <br />� FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />� HEAT PUMP _ <br />� UNITHEATERS—B.T.U. M <br />VPCANT SITE <br />flYES fl NO <br />SI2E OF BLUG/TI. <br />❑YES f7 NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METALFIREPLACEI <br />FIREPLACEINSERi <br />GAS FIREPLAC <br />GASRANGE <br />6AS PIPING <br />EXHAUSTFAN <br />pIAN CMECK <br />r <br />BUILDING <br />PLUNf11NG <br />MECIIANICAL <br />A�DIPONALPLANGMECK <br />�� <br />OTNEP <br />�__ <br />STATE BURUING SVRCHARGE <br />PUBI.IC WORKS <br />TOTAL <br />SUA TOTAL S �__ <br />PERMIT $ � <br />TOTALFEE $ ' <br />FEE jrl RECEIPt% Q � (� � <br />p' , (l � � �i <br />��� <br />