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� <br />. � APPLI�AT11,r�! FOR CONSTRUC7.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 (:EDAFi STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ pLUMBING � SIGN <br />PROJECTADDRESS: '��,�� C=ve2�h�E.:� Wl�� <br />��Ep MAILAODRE55 <br />��ry Z�� PHONE <br />Vyt�s C�. st�s� ,3z.�u j <br />l�VG S� Sttr�- j�r. ISCLLGtiY1L ✓ir RSccC e <br />TEN�NT MAII�ORE55 �2��%�y3 /3co <br />CITY <br />C <br />� Di <br />h�LST <br />/NS'GS" iY'c `7lY St <br />M�IL A�DRESS <br />/ySCS /I�`E `1/S�S+ <br />wi� rySiryr <br />/ZEOiw�vO � I,,,%� '7505 z <br />CIiY Ilf+ <br />UNoN4� iJ/F ?SC�L <br />-/92 <br />3L 9- 5"2 �i <br />&G 9 -S2 <br />��TM Z�P P110NE SATE LILENSE � <br />PLUMBINGCONTFACTOR AIAILADDRESS ��ry Z�P <br />PNONE S7ATE LICENSE � <br />LVN ,NI1GT PpICE OF WpqN <br />A S b��o <br />�cx.nint WpqK AND SOUARE FOOTAGE INVOLVED <br />1 <br />rliOPOSED USE OF BUILDINC <br />�� <br />LEGAL OESGRIPTIIXJ OF PqpP( <br />l0T BLOCN <br />BELOW Op ATfACH TWp COPIES) <br />CONSTRUCTIpNLOulLENDER,MDRESS.TELEPHONENUMBEfl <br />TYPE OF FlICTURE Op <br />WATER CLOSET (TOILET) <br />BATHTUB <br />SHOWER <br />KITCHEN SINK & <br />LAUNDRYTPAY <br />CLOTHES WPSF <br />�RINKINu FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVcNTERS <br />SINK (SERVICE — BAq, ET <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE E <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK qE�R SETB�CN <br />USE ZONE � / lOT MEA <br />� <br />HEIGIITLIMITATION NO OF OWELLING <br />UN115 <br />Oi SIORIES <br />FIRE <br />-S,5 <br />SIDE SETOAC1c <br />V�CANt SITE <br />❑YES ❑ ND <br />SIZE OF OLDGR.1 <br />❑YES ❑ NO <br />HEATING SYSTEM: � GAS ❑ ELECTRIC ❑ <br />CONTACT PERSON R!D PMONE NO. <br />UCI�c�. 7RfUUFo (t�b%5�9-52.�3 <br />I HEREBY CERTIFY THAT I HAVE READ ANO E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOV[RNING TH�S TYPE OF <br />WORK WILL �E COMPLIEO WITH WHETHER SPECIFIE� HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHEp STATE OR LOCAL LAW REGULATING CONSiRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BV THE <br />OWPlER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW iB27 RCW AN� 2g6.200 WAC. <br />x _�- � lo/a �i /9C <br />S�L-Y.A!L',^.� `'� %'� O�TE <br />P <br />CITY BUSINESS LICENSE NO. <br />MECHANICAL <br />NO. TYPE <br />A/C —lVHNDL <br />FORCED AIR S <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRY <br />R,4NGE HOOD <br />WATER HEATEP <br />WOOD STOVE <br />MEfAL FIREPIA <br />FIREPLqCE IN51 <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />IXHAUST FAN <br />PUN CIIECR NUMHEfi <br />UIIIL�ING <br />PLUMOING <br />MECHRNIGL <br />AODIIIONAL PUN C11F.CN <br />OIIIER <br />$TAIE OUILOINO SUfiCHqpGE <br />C1TY OF EVERETT rumir.wonKs <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL E <br />PERMIT 5 <br />TOTAL FEE S <br />fEF �� REf.EIPT NO <br />FEE <br />