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APPLICAYIG J FOR CONSTRUCT �N PERMIT <br />CITY OF EVERETT • BUILDING DIVISIQN <br />3200 CEDAR STREET • EVERETT, WA 9820 i• 259-8810 <br />N <br />❑ OEIlOLITIUN ' ❑ COMBINATION � BUILDING ❑ IiAECHANICAL ❑ PLUMBING ❑ SIG <br />PROJECTADDRESS� ro�0 t�e�qlreen� f-UO�� <br />-r� � .-� . .._ . _i L --�-rrr-nx—c'-��-r-i-0�ri _ i i _. .. . �. C�"Q7�'i{27'�� L.7 - �.rl� .� <br />TENMl7 MAIIMORE55 CITY � ZIP I PNONE <br />� s: n ll/ <br />/�RGMIECTOFDESIGNER MNLAODRE55 GITY IIP vHONF <br />Mui <br />zm <br />MECNIWIr,upppiq�CTOR M�RADDpE55 f.ITY ZiP PHONE SuiELICEHSE� <br />MUMBI GCONTH�CTOR M�IL/�WRESS CIN Z�P VHONE ST�TELICENSE� <br />PRICF. <br />LOT <br />I�AqLELTiUf I.D. <br />tlLOCN <br />FooT�ce ir+vaveo <br />C�. _ <br />CONSTRUCT�ON LONI LENDER. �W PESS. TELEPHONE NUMBEfl <br />PLUMBING <br />NO. TYPE OI <br />WATER CLOSET <br />BATHTUB <br />KITCHEN SINK <br />CLOTHES <br />FLOOR ORAIN <br />BACKFLOW PREVENTERS <br />GLit�i .. <br />SUB TOTAL <br />YC:i9 <br />S <br />FOR OFFICE USE ONLY: <br />FHONT SETBACK pE�R SETB�CK S�OE <br />USE ZONE <br />NEIGHT LIMITATION <br />�� <br />7 REO'0 <br />Y�� <br />10T11REA V�CIINTS�fE <br />❑YE$ ❑ NO <br />NO.OFOWELUNG SREOFBLDGrtI <br />UNIfS ,� J_� �L <br />�� �1 <br />OCCUPANTIOAD BASEMENT <br />g'C% ❑YES �NO <br />aEA50N �p� /�yr cSn n <br />VfY/�/V�11'KTr /�/ IV� L.7 <br />REASON ��� <br />IFf,ONST P��NSFPP�H1OVEDBY CITVOFEVERETT <br />—�`� v� ' 1 TAX CODE S 3 OS <br />oaTE 3/3 �G <br />HEATING SYSTEM: �GAS �ELECTRIC ❑ <br />I H�REBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CARREGT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH �1HETHER SPECIFIED HEREIN ON <br />NOT. THE 6RANTING 0� A PERMIT DOES NQT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM F,UTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />x � . � a �a-� �q h <br />SIGN�TURE UATE <br />CITV BUSINESS UCENSE NO. <br />MECHANICAL <br />NO. TYPE OF E�UIPMENT FEE <br />FORCED AIR ; <br />HEAT PUMP <br />UNIT HEATEFI <br />CLOTHES DR� <br />FlANGEHOOD <br />MEfAL FIREPLACE I <br />FIREALACEINSERT <br />GAS FIREPIACE <br />GAS RANGE <br />IXHAUST <br />SUB TOTAL S <br />PERMIT 5 <br />TOTALFEE S <br />IELK Nl1MBEf1 FEF RECEIPT NO <br />G �JJ � — <br />OUILL`:NG <br />PLUMBING <br />MECMRNILAI <br />ADDIiIONAL �LAN CNLLN <br />0111Efi <br />SfATE fl111101NC SU�CNnRGE <br />P1181If, W0f1K5 <br />TOTAL <br />