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APPLICATIVr�I FOR COI�lSTRUCT ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-0810 <br />❑ DEMOLITION fl COMBINATION f-1 BUILDING fl MECHANICAL �LUMBING f 1 SIGN <br />PRO.IECT ADDRESS <br />tc � <br />zir <br />( ZI�I 1'lIV1VC <br />t �u��c.c.�i- �37-S15'S lo <br />; " - zir rrione <br />an urrcT on o �r�t�+ ,• ���•• �I' . <br />� /� � � � �C"'�—Y - J t'„ ,uI — CIIY 71P PIIONE SiAiE lIC[NSC � <br />G@N-f1�LGONIR�G10� MAll.AOpB[55 <br />MECHANICALCONTR�CTOP MAILADDRESS <br />CIN ZIP PHONE $7ATELICENSE� <br />PLUMDINGCONTRFCTO� �aAILAbUPE55 Cltt ZIP PHONE STATEUCENSE� <br />-- ..i i ..__ _ ._� �2h n ,..,� �nn.�r..c.,Jf. QP,�7rz /.t�Z%7i4f'�o 7'�f PLCyt U�7 <br />ANO <br />�aT BLOCK <br />INVOLYED <br />GONSIRUGCON LOA�� LENDER. ADDf�E55. TELEf'HONE NUMBER <br />hp, TYPE OF FIXTURE <br />WATER CLOSET (TOILEn <br />BATHTU6 .._ <br />8 DISP <br />TRAY <br />SINK <br />SUB TOTAL <br />TOTAL <br />5 <br />FEE <br />FOR OFFICE USE ONLY: <br />fRONTSFTOACK R[A� SF.TBaCK SIUE SETBACK <br />USG ZONE <br />IIEIGMT LIMITATION <br />OCCUPRNC� ��0 Of 5�� <br />GROIIP <br />FlRE ALA(1M REO�O <br />FIRF. SPPINNIERPEOD <br />rme or r,or+sr <br />HEATING SYSTEM: f � GAS �l ELECTRIC fl _ <br />�C`�TALT PERSON AND FIIONE NO <br />I HEREBY CERTIFY THAT I HAVE READ ��D EXAMINED THIS <br />APPLICA�ION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE O� <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION UF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMAl10E OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEFi OF THIS PFiOPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT�TORS LAW 1827 RCW AND 296.200 WAC. <br />X r�-' 2G� f-- �6�' �i�.i7��'s� <br />SIGNRTURE OAT <br />CITY OUSIMh55 UCENSL NO <br />NO. TYPE OF EQUIPMENT � FEE <br />FORCED AIR SYSTEMS - B.T.U. M E.A. <br />UNIT HEP.TERS - B.T.U. <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEA7ER <br />WOODSTOVE <br />METAL FIREPLAC� <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL 5 � <br />PEfiM � S � <br />TOTALFEE 5 ; <br />rue+e�ieck r+un�nFn rEe I nFCEirr r+o <br />LOTPREA VACANISIfE <br />I IVES �' ��0 OUILOING <br />NOOF�WELLIN6 SIZEOFBLDG4� <br />UNIi$ ClU1J131NG <br />OGCUPANT LOA� BASEAIENT MEC11aNl[nL <br />I H'ES f� NO <br />/.D�IIIONAI. Pl��� G�ffCN <br />RpA50N <br />O711ER <br />REA�OY <br />STAIE OWl01NG SIIRf,114RGE <br />vinNsnrrnoveoov CITY OF EVERETT ruonr.wonks <br />LOCALSALES <br />OATE <br />TAX CODE IS 3105 707AL <br />C <br />