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APPLICATIGA FOR CONSTRUCT �ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />I-1 DEMOLITION fl COMBINATION fl BUILDING fl MECHANICAL � l PLUMBING SIGN <br />PROJECT ADDRESS 9 6 bs — A Ev(,� re��,,� 11la ��%��- % g�-d � <br />/Q- <br />OWNER, C � "`�� <br />MAILRODRESS PHONE <br />Y�l�% (�j�/iA/G �( 6 t� � �C'�'c�l` -�k Wj/.Y �.(/�/ �rr� 1 r'%�.Lo� <br />TENPNT MAILAOORESS Cltt Z�P � <br />PIIONE � � A � � � <br />liNli--� NGllY�t/ 96oSi}- ,Ev�r w! ./=Yere/f- �Zo'f � <br />ARCHITECTOROESIGNGR MPII.AOORESS <br />c�n zm rMone <br />�. _1/ �".•___ _ <br />CONTRACT qFM�E�3Fj WORN A /'6 � �/ <br />�� d'C/ I v <br />UESCRIBE �"�ORK AN/D SOUARE FOOTAGE INVOWED �� <br />__. �'i�I�C— 11 i .O `P <br />�,� , 3 x��� <br />G� c. s� di a <br />PROF'OSED USE OF BUILOING <br />LEGAL OESCFlIPTION OF PPOPER7Y (SNOWN BELOW OR ATTACH T <br />LOT tlLOCK _ OF <br />PARCELTA%ID.NUMBER <br />�01-6-I�-438� <br />CONSTFUCTION LOPN LEN�ER, /�DDFESS. TELEPHONE NUMBEF <br />NO. TVPE OF <br />WATER CLOSET <br />BATHTUB <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />UPINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN' <br />SINK (SERVICE — BP <br />OR <br />arv ��� <br />Cltt 21P P <br />HEATING SYSTEM: 1'� <br />CONTACT PEHSON AND PIIONE NO., <br />, _ _ r , ;., .0 _ T,�, <br />FEE <br />STATE LIGENSE i <br />IICENSE � <br />GAS f-I ELECTRIC �� <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 />NOT. THE GRANTING OF A PERMIT DDES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER Sl'ATE OR LOCAL LAW 9EGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BY THE <br />OWNER OF TH�S PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THF STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />' ���� <br />� , /� -//- 9S <br />X � <br />SIGNATI/RE OATE <br />CITY BUSIN@S$ LICENSG NO. <br />___"- <br />NO. TYPEOF�EQUIPMENT FEE <br />q/C A/HNDLGUNRS—HP <br />—� FORCED AIR SYSTEMS — B.T.U. M t.A. � <br />UN�T HEATERS — B.T.U. M <br />CLUTHES DRYERS <br />VENTILATION FAN <br />� RANGE HOOD <br />, WATER HEATER <br />WOOD STOVE <br />; METAI FIREPLACE (WOOD <br />� FIREPLACE INSERT (WOOC <br />� GAS FIREPLACE <br />GAS RANGE <br />GAS P�PING <br />� FXHAUSTFAN <br />SUBTOTAL 5 <br />SU8 TOTAL S � PERMIT S <br />PERMIT S ' TOTAL FEE S <br />TOTAL FEE S ' <br />FOR OFFICE USE ONLY: FEE RE�eirrNo <br />FRONT SETPACN REPR $FTBAGK SIDE SET9ACN PLAN CIIECK NUMOER ' <br />� � � �� �J <br />USE ZONE �AE� <br />VACANTSITE FcES VALUATION <br />C_� /J,f 1�? 41VE5 fl NO BUILOING <br />��a <br />... � o.�...�nu r�n �LLING 52E OF GLDG�TI <br />oFr,oNsi .�.�rvn,.� -` .�..,.. <br />�I� �` <br />�ATE � ��� � �'1 �� <br />PI IIMOING <br />SEMENT MECIIRNICAL <br />I1YE5 I1 NO <br />PpDpIONAL PI�N G��F.CN <br />OiliE� <br />STATE O�11101NG SU(iCHnRGE <br />CITY OF EVERETT �'����If, WOFiNS <br />LOCAL SALES — <br />TAX CODE IS 3105 707a� <br />