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APPLICATION FOR CONSTRUCT�ON PERMIT� <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOUTIOk �COMBINATION �7( BUILDING fl MECHIANICAL .�rPLUMBING I-1 SIGN <br />PROJECT ADDREce <br />� <br />/�/� Z �S�' � / , �/ .�.Ca lz� <br />MAILRDL` 55 GITV IIP P�NFi— ��� <br />'�/�ss. �/o .���2�.�-/Lluu�'«��� r�Foa 5����dfM�.c((,� , �u� l,l�H- <br />�` MpILADORE55 / CIN �1 q21P ,n q� � <br />fl' �JCPZ"' �✓PY� M`�l(�S�9Cr jl'% li i�DA- 7l't '���oNl�t WF �i7fJC u.i�- �C` <br />�CTOR E��:�MAILA9� RE55 / LITY L IIP/ � PH/011FI1 1 / ),,\ �1 <br />O /1l�0 P` �j��joCtrc'f� / Li'7 finGln �kCC �9iN U" i�C� P...�S (`Tn 9 i W� �f S l �U 1 d''�b� 8�'d�'S�' <br />l�✓II��pR��+R��s O��/_I��I,"'P�C L�iV�/IC..�Kr WViGr�'� $TA7ELIC[N uIL. NioG3K <br />�° 7 388-�3��- B D <br />ICAI'CONTRACTOB MAILADDRE55 CITY ZIP � PHONE SThTFLICENSE� <br />�' N L(� (V rM � lY�(' L d <br />� d <br />CONTHAGT PRICE OF WORH <br />��, OC�� <br />DESCRIBE WORN AN� SOVr1RE FOOTAG INVOLVED <br />���u�l ��rs�'us sP�� rU <br />_(u-�as ��,P o(d �cv(�Je �o. @ c <br />— e o[4 �P J,,v�h i —�l Pw ('R <br />PROPOS USEp F6UILUINp <br />r�� I s4/�s o o✓� a�1 <br />�or <br />OF PROPEFlTY (SHOWN BELOW OR ATfACH <br />_ BLOLK OF <br />Ma L� �04 c.e <br />TELEPHONE NUMBEH <br />N0. TYPE OF flXTURE OR I7EM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN �� (�Ct �, <br />FLOOR DRAIN —� � <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAq, ETC.) E-� <br />1✓ M�N cYl <br />ew lvov- S:�n S <br />e I clra��n <br />5 c�rit <br />SUBTOTAL S <br />PERMIT 5 <br />TOTAI FEE S <br />FOR OFFICE USE ONLY: <br />FRONiSETAACK REAR SEiBA�K <br />USEZONE LOTAREA <br />❑EIGIITLIMITATION NO.OPOWELLING <br />UNIIS <br />1 <br />UA7E <br />PHONE STATE LICENSE • <br />HEATING SYSTEM: ❑ GAS fl ELECTRIC fl <br />CONTACT PERSON AND PHONE N0. <br />b�r,�S I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE T9UE AND CORRECT. ALL <br />�, ,,; ��� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />�- "� � WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />'°� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO Gib'E <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />�/ OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />y-� � PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />X � �N� �o���l�s <br />SIGNATURE pATE <br />CITY BUSINES$ LICFNSE NO. <br />TYPE OF EpUIPMENT V <br />A/C—NHNDLG UNRS—H.P. <br />FOACED AIR SYSTEMS — B.T.U. M E.A. <br />HEAI' PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES �RYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT (WOOD BURNING) <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE S <br />SIOESET�ACK I PLANC�ECNNU UE� I FEE/�/, ���I �ECGIPTNO. <br />�975 <br />VACANi SI7E FEES <br />f1YE5 fi NO BWLDING <br />512E OF �LOO/I.I <br />PWMOING <br />BASEMENT �r[GIInNICAL <br />f7YE5 fl NO <br />ADDIIIJN�L PL�N GiIiGK <br />OIHER <br />STNE OUILDING SUpCHnqGE <br />CITY OF EVEFETT �'��BLIC WORKS <br />IOCALSALES <br />TAX CODE IS 3105 TOTAL <br />