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APPLICATII�:� FOR �ONO�TRUC'� .ON PERMIT <br />CITY OF EVERETf • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: �7 � G� GL'� (L�=E� G�'/4 `� <br />� <br />1�c r.�i,..�2 �,� n. n...,._.. , nA,.,r.,��R nn �7��r� Sd.l 4I/„ f",iy2 <br />�/,��1 i!'1/ii+AR '�//ZPS 47'tm �v�r7�R��K k�/�C/ �O.�l� ��77 /%f6E �(E'� <br />TENANT M�II.ADDfiE55 � CI V llf� �IIO <br />ARLHI�ECT OR DESIGNER MNl ADOBE55 GIiV ]�P PIIONE <br />L•S• /�cFlSY2�CTtGi'F OY�iu�v��[E rS� 9775k- ___.�.� 4�B6 eg`�' <br />GENERAI WNiqACTOR M�ILADDR 55 CIIY lIP P��ONE SIATE LICENSE � <br />MECHANICALCONTRACTOR MAILpDDRE55 CITY ZIP PHONE STATELICENSE� � <br />PLUMBING CONTRACTOP M�ILADDRESS CIN LIP PHONE STATE LICENSE � <br />--.....__.....__ �/.... �.� 1 ` <br />OESCRIBE WORK �ND SOUAPE FOOTAGE INVOWED <br />� <br />LEG�I DESCRIPTIIXi OF PPOPERTY (SNOWN BELOW OR ARALN <br />LO7 BLOCB OF <br />CONSTRUCTION LOAN LENDEP, ADDRE55, TELEPHONE NUMOEA <br />NO. <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORY (WASH BA.' <br />SHOWER <br />KITCHEN SINK t� D19P <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URIPIAL _ <br />DRINKING FUUNTAIN <br />fLOOR DRAIN <br />BACKFLOW PREVENTERS <br />FOfl OFFICE USE ONLY: <br />FRONT SETBACN REAR SETBACK <br />u5E ZONE <br />HEIGHT LIMITATION <br />OCCUP/.NGY HO 0� 5 <br />GRjJ_VP <br />��i <br />FIRE�SJPf��'IN[NLERREO'D <br />/ �. 1 <br />FIREAWiM; J <br />y�f <br />ITEM <br />FEE <br />SUBTOiAL S <br />PERlAIT $ <br />TOTALFEE E <br />LOT�nEA <br />NO OF DWELIING <br />UNIiS <br />OCCUPANfLOAD <br />REA ON � <br />O+L9 <br />AE/SON <br />�rco <br />—���--�=ie �'��o_ <br />SIDE SETBACN <br />VACANT SITE <br />❑YES ❑ NO <br /><IZE OF BLDG?I <br />N/i <br />OYES ❑ NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONT�CTPEf150NANDPHONENO �`"� �� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COF.RECT ALL <br />PROVISIONS OF LAWS AND ORDIP:INCES GOVERNING THIS TYPE OF <br />WOFlK WILL BE COMPLIED W�TH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANC�L THE PROVISION OF ANY <br />OTIiER STATE OR LOCAL LAW REGULAT'NG CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. TFiAT � AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WH�CH <br />APPLICATION IS MADE AND I COMPLY WiTH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 V1AC. <br />J <br />x , � �vz�-� �.� /�' - <br />SIGN�TU(lE ATE <br />CITY IIUSINESS LICENSE ND <br />MECHANICAL <br />NO. TYPE OF E�UIpMENT <br />FORCEO AIR SYSTEMB <br />HEAT PUMP <br />UNIT FIEATERS _ <br />CLOTHES ORYERS <br />RANGEHOOD <br />�NOOD STOVE <br />GAS <br />GAS PIPING <br />EXHAUSTFAN <br />PIAN f.11ECN <br />ouuowc <br />PLU��INC <br />MECM�NIf.AL <br />nDD1710Na1. PUN CHF.CK <br />on��n <br />srn'�e owiou+r sunc�i.+nce <br />PuS� u: wonNs <br />TOTnL <br />� <br />: <br />SUB TOTAL 3 �— <br />PERMIT S � <br />TOTALFEE E ' <br />FEF RECEIPi NO <br />VAIUATION FEE <br />i <br />�3d ;;?c� <br />Sv <br />i � v <br />-- - - ----�'1 �. -� ' <br />