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�. <br />APPLICATIO.J FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ��COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTADDRESS: �%�GL S� ���/z�TT J11/TL�- W/�I <br />�NrtIEN MNLAODRE55 CITY IIP PI�ONE <br />�v�fi�' n�Rc,�- 14a2 s� t-�Fi��1T� Mq�- w,ay �►'�1.7"i iB zo8 7�3-z7z� <br />LEGAL <br />�ot _ <br />CONTRACTOR <br />BIOCK <br />MAII <br />CONSTRUCTiONLOANLEN�Efl.ADDAESS.iELEPMONENUMBER <br />PLUMBING <br />NO. TYPE OF FlXTURE OR ITEM <br />WATER CLOSET (TOILE� <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK d DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.1 <br />COPIES) <br />FEE <br />0 <br />SUB TOTAL S <br />PERMIT E <br />TOTALFEE E <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAR SETBACN <br />USEZONE IOT�RE� <br />HEIGHT LIMI7ATION NO OF DWELLING <br />UNIfS <br />OCC07ANCY NO 0� SIONFS OCCUPANT LO�D <br />�('� IPLnNS�PPnOVEDBY <br />`�y% t, <br />SIDE SE7BACK <br />V�CANT SIfE <br />❑YES � NO <br />PHONE <br />rir <br />� " " _ <br />� <br />ENSE • <br />ZIP ) PIIONE L ST�TE UCENSE � <br />—�'�' 7 �dalo� I C� �!N G <br />ZIP PHONE STATE LICENSF � <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ��_ <br />CONT�LT PERSONAND PHONE NO <br />' I�rr►�/p �. �h�i��1�� - z6q� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NDT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEI THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHOqIZED 8Y THE <br />OWNER THIS PflOPERTY TO PERFORM THE WORK FOR WHICH <br />APPLIC IS MADE AND I COMPLY WITH THE STATE <br />CONTR �1827 RCW AND 296.200 WAC. <br />x LS 6 <br />SIGNIITURE OATE <br />CITY BUSINESS IICENSE NO. <br />TYPE OF EOUIPMENT FEE <br />A/C—AMNDLG UNfTS � <br />FORCED AIR SYSTEMS ; <br />HEAT PUMP , <br />UNIT HEATERS � <br />CLOTHES DRYERS ; <br />RANGEHOOD � <br />WATER HFATER � <br />WOODSTOVE � <br />MEfAL FIREPLACE (WOOD BURNING) � <br />FIREPLACE INSERT (WOOD BURNING) � <br />GAS FIREPLACE � <br />GAS RANGE ; <br />SUBTOTAL S <br />PERMIT S <br />TOTALFEE S <br />PLANCIIECNNUMB[R I �EF / b I REf.F.IPINO <br />pI11LDING <br />SIZE OF BIDGRI <br />i��' 'T,. rwuoiNc <br />BASEAiENi MEC11nNICpL <br />❑YES �NO <br />AD�IIIONAL PUN GHf.GK <br />ouien <br />_ STATE BUIIUING SIIfiCHRfiGE <br />CITY OF EVEREI"f ruenr, woeKs <br />LOCALSALES <br />TAX CODE IS 3105 70TAL <br />