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APPLICAT14rd FOR CONSTRUCT �ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />fl DEMOLITION fl COMBINATION I-1 BIIILDING f� MECHANICAL rl PLUNIBING �l SIGN <br />PROJECT ADDRESS <br />��(vo/ EvE-��-�/ W,wy-J.c�.�b1 <br />OWN MAILADORESS CITV � ZIP PIIONE <br />/� �• /�_ � ! �7/� ,/ <br />�O.I � / D ��� l��.� `_..� �.���� Yr1 ���P �Y� - � j6L7 <br />1ENAN MAILAOORE$$ QTY ZIP P�Ny NE <br />Cff,4,v�S il�,vc3ou�,,�/ C',�i LL 7��/ E-vC�� RE&�tf (�-i:v�-� G,�.cr�i--f- 9s2� 3(Z"�'� "35�7 /9zS <br />- � OR OESIGNER MAILADpRE55 <br />PMONE <br />GENEPALWNTMCTOR MNLA��PE55 �IIY 21P PIIONE STFTELIC[NSE� <br />S�.u=ru �G'u-c�� �4nis— (�b-Fti� S. kc-,.�-r �-so3z zob— �s-� �-�m� <br />ME H�NICAICQNTRACTOii MAILA�ORE55 CITV ZIP PIIONE STATELICENSE� <br />r-f�-F� rc .� ln7o J'. C�C� �- � Sc�s/'r�F Qi810£� 2r� --7�02 -/�( S'b <br />PLl1MBINGCONTRACT R MAILAODRESE Cltt ZIP PHONE STATELIf,ENSE• <br />5'�4 Fc-T'TI i o fzG <br />CONTflACTPRICEOF�' fiK <br />Yy��oOD• �`—' HEATING SYSTEM: fl GAS f 1 ELECTRIC ! l <br />UESCRIBE WOFK AHD SOUARE FOOTAGE INVOLVED � CONTACT PERSOY ANO PHONE �l0 . <br />LEGAL DESCRIPTION OF PROPERiV (SHOWN BELOW �R ARACH TWO COPIES) <br />LOT _ BIOCN OF <br />PARCELTA%I.D.NIIMBER <br />CONSTFUCTIONLOANLEN�ER.AUDRESS.TEIEPHONE NUMBER <br />PLUMBING <br />NO. TVPE OF FIXTJRE OR ITEM <br />BATHTUB <br />LAVATORY(WASH BASI <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />UAINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTE <br />SINK (SERVICE — BAR, <br />FOR OFFICE USE ONLY: <br />fFlONTSETBFGK REAR SETBALK <br />USE 20NE <br />HEIGHT LIMITATION <br />LOTAqEA <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE 5 <br />SIDE SETBACK <br />NO OF �Y/ELUNG <br />UNIiS <br />LOAD <br />FEE <br />vacaHr sire <br />f1YE5 fl NO <br />517E OF BLDGRI <br />f1YE5 fl NO <br />oFr,oNst vinNsavrnoveoov CITYOFEVERETT <br />LOCALSALES <br />uqTE J �/�/�7(p TAX CODE IS 3105 <br />_�o � 1 76 2 —/SC,r-z� <br />� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNGW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMf•LIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTIPli; OF A PEfiMIT �OES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICFI <br />APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1 7 RCW AN� 296.200 WAC. <br />x �� _ /— �9� <br />SIGNATl1RE � OZ 333g �9AT <br />CIN �USWE55 UCEhSE N0. <br />NO. I TYPE OF EOUIPMENT <br />rvi.—rvnrvuw vrvi�a—n.r. <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />NEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />FIREPLACEINSEI7T <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />�' /)O '- /..�= �. <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE S <br />PlANC11ECKNUMOFR FEE fiECEIPTNO <br />50�73 �� <br />FEES VALUATION <br />�OIIDING <br />PLUM�ING <br />IAECNnNICAL <br />nooi uorini_ r�nN c��ecK <br />OTIIEP <br />STAiE �Wt�l4G SUtiCHMGE <br />runi ic wonKs <br />TOTAL <br />