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APPLICATI�'W FOR CONSTRUC�.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOUTION ❑ COMBINATION ❑ BUILDING MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: q� 3U G/�YAYP.CY� W�UTA V I U. fJ — <br />� <br />�RCNITECT OR DESIGNER Mql AD�RE55 ��TY 71P PNONE <br />GENER�I LONTR�CTIXi M�ILADORE55 CIiY IIP PIIONE SGTE LICENSE � <br />�i_�L� �...f..., �,.�� t�.� in;.b'�t�F i��ri_ CFv IUU �#l� qSl3�F �1�4'2 A`f5`� U�viTe5zi7b��& <br />CIiY ZIP <br />CITY ZIP <br />� 1950.�� <br />LONTRAGT PRI E OF WOPN <br />OESLPIBE WORNAND SOU�RE F TAGE INVOLVED <br />I„stxl �� new t Ff usevs ; <br />Rrlocab� �4 d�fFuSevs � I ve� <br />-l�her ry,os�at <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PHon <br />l0T 9tOCK <br />r�nce� r�x i.o. nurneEq <br />l3�&c,4- 3 - oaa - o00 � <br />CONSTRUCT�OH IOAN IENDEH. ADORESS. TELEPMONE NUMBER <br />PLUMBING <br />NO. TYPE OF flXTURE OR ITEM FEE <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWASHEH <br />LAUNDRYTRAY _ <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOF DRAIN <br />BACKFLOW PREVENTERS .__ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR SETBACN <br />USEZONE <br />HEIGIIT UMITATION <br />NO <br />OF <br />SUB <br />S <br />a <br />S <br />SI�E SETBACI( <br />STATE LICENSE i <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />LONi�CT PENSON AND PHOWE NO. i �_ i �_ . <br />� <br />I HE.REBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS <br />APPLICATION �.ND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PRO`JISIONS 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 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 PERFORM THE WORK FOFi WHICH <br />APPLICATION IS MADE AND I COMPLY WI1�H THE STATE <br />CON RACTORS L 1827 RCW AND 296200 WAC. <br />X _ � a��q� <br />SIGNATUq� D�TE <br />0 'at�7 � 1)� <br />CITV BUSINE55 LiCENSE NO. <br />NO. I TYPE OF EOUIPMENT <br />ivv —.v.,�.v�., .n.� � <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />CLOTHES DR' <br />RANGEHOOD <br />PIPING <br />SUB TOTAL S <br />PERMiT E <br />PUNClIECBNUMBER I FEE I �ECEIPiNO <br />l0T �REA V�C�NT SITE rc�o <br />❑VES 0 NO pUILUINC <br />NO.OFDWELLING SREOFPLOGRI <br />UNIfS P�IJMOING <br />OCCUPANTLO�O BASEMENT MECNnNILAL <br />❑YES ❑ NO <br />AUDITIONFL f'lAN CMFLR <br />{iEASON <br />0111EH <br />REA$ON ' <br />STAIE BUIIDING $IIRCHAfiGE <br />PL�NSRPPROVEDBY ClTY OF EVERETT �'1I011f. WpRNS <br />LOCAL SALES <br />,,.,� TAX CODE IS 3105 TO7AL <br />