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i 'ti �i <br />APPLICAT14�1 FOR CONSTRUCT�ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />fl DEMOLITION �l COMBINATION fl BUILDING MECHANICAL I� PLUMBING �l SIGN <br />PROJECT ADDRESS � <br />9�a5 e��Ct�F�ti r,�,� � <br />OWNER M4ILADDPE55 Q ZIP PNONE <br />yr,i ,� N t,.�af��i /� Z�P � G>3� ,,S'� Sf �, � 3� - z//� <br />TENANT MAILADORESS LITY ��P��C,�� PHOVE <br />7 <br />ARCHRECTOROESIGNER 11AILAOURE55 GITV ZIP PHO�E <br />GENERALCONTRACTOR �AaLACDRE55 GITY IIP PIIONG SIATEUC[NSE• <br />MECNANICALCONTRACTOR MAILP90RES5 cirr ZIP PIIONE STATEUCEN�E� <br />PLUMBING CONIRACTOR <br />CONTRACT PRICE OF WORK <br />�z, ��Y <br />UESCRIBE WORN AND S�OUARE FP <br />/N57,ql� � C; <br />l/�JrTS i 2 - <br />� — /25Ga� ,aru <br />PROPfJSED SEOFflUIL01NG <br />LOT BLOCK <br />TAXI.O.NUMBER <br />CUN°TRUCTION LOAN LENDER. ADDRESS. TELEPMONE NUMBER <br />N� TYPE OF FIXTURE OR ITEM <br />WATER CLOSET lTOILETI <br />LAVATORY(WASH BA; <br />SHOWER <br />KITCHEN SIVK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />DAINKING <br />FLOOR OF <br />PREVENTERS <br />CF — RAR F7 <br />STATE UCENSE • <br />HEATING SYSTEM: �GAS rl ELECTRIC �l <br />LONTACT PER501! AND PHONE NO. '/ <br />K1�in� %G-.�%�?. <br />5 Ta,� <br />�� 2� �6� I HEREBY CERTIFY 7HAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAMG TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS A."JD ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />wocories) NOT. THE GRANTING OF A PERMIT DOES NOT PqESUME 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 PEFlFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND � COMPLY WITH THE STATE <br />CONTRACTORS lAW 1827 RCW AND 296.E00 WAC. <br />�� �� <br />SIG UF DATE <br />CItY BUSINESS UCENSE NO. <br />SUB TOTAL 3 <br />TOTAL FEE S <br />NO. TYPE OF EOUIPMENT <br />r— <br />� A/C—A/HNDLGUNRS—H.P. <br />; FORCED AIR SYSTEMS — B.T.U. M E.A. <br />� HEAT PUMP <br />' UNIT HEATEFlS — B.T.U. M <br />� CLOTHES �RYFRS <br />� VENTILATION FAN <br />� RANGEHOOD <br />i WATER HEATER <br />' WOOD STOVE <br />� METAL FIREPLACE (WOOD BURNING) <br />� FIREPLACE INSERT (WOOD BURNING) <br />; GAS FIREPLACE <br />� GAS RANGE <br />GAS PIPING <br />� EXHAUSTFAN <br />� — <br />� SUB TOTAL S <br />� PERMIT 5 <br />! TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSEiPACN REARSETBACN SIOESETBACN PLAN <br />IISE IONE <br />MEIGNT LII.HTFTIDN <br />f' <br />IOTRREA VACFN�SIIE FEES <br />— (IYES fiNO OUILDINC <br />�+J OFDWEILIPIG 512EOFBLUGRI <br />UNITS <br />PUIIdpING <br />OCCUPANTLOAD BASEMEN7 �f�C11ANICAL <br />IIlES il NO <br />RF.A50Y ADDI110N�I. PL�N CNF,CK <br />OTIIER <br />AEASON <br />STNE OUIIDING SURCIIAq[E <br />ctnNS � QrvED BV CITY OF EVERETT ❑UpL�f, WORK$ <br />�l'� LOCAL SALES <br />nniF / n_//_ . S i TAX CODE IS 3105 70TAL <br />f[[ I AECFIPT NO. <br />