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APPLICATIO�inl FOR CONSTRUCT�ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />❑ DEMOLITION fl COMBINATION fl BUILDING ❑ MECHANICAL � PLUMBING fl SIGN <br />TEN�NT <br />GENENPLCONTRAC70R MAILADORE55 <br />Gt 7G'/V <br />ZIP <br />QIY ZIP PIION[ SinjE LIC[NSE � <br />� 1' [S�-l..C�. /.i U S / � /� J OroJ / " .y3~. <br />M1IECNANI AL CONTRACTOi7 MAIL ADURE 5 ITV l.lP PIIONE . l�T[ IICGNSE � <br />PW6181NGCONTRAf,TOR MMLA�DPE55 CIN 21P PHONE STATEUCENSE�.TR�sr� <br />OESCRIOE WORK ANU SOUARE FOOT�GE INYOLVED <br />PROPOSED USE OF BUILOING <br />LEGAl0E5CRIPTION OF PROPERTY �SNOWN BELOW OI <br />LOT BIOCN OF_ <br />PARCELTA%ID.NUTABER <br />I'�2�-d�►3 -o�-�-000� <br />CONSTRUCTIONIOANLENUER.PDDRESS.TEIEPHONE <br />NO. I TYPE OF FURURE OR ITEM <br />BATHTUB <br />LAVATORY <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOF DRAIN <br />BACKFLOW PREVENTERS <br />CINKISFFIVICF—RAG Fl <br />FOR OFFICE USE ONLY: <br />fRONT 5FiP4f.K REAR SFTBACN <br />USE 20NE <br />HEIGHT LIMITATIOI! <br />OCGbVANGY NO 0� 510a1E5 <br />G90l/P <br />IOTAREA <br />FEE <br />SUB TOTS.L 3 ; <br />PERMIT S � <br />TOTALFEE S D ' <br />SIDE SET�ALN <br />NO OF DWELIING <br />UNiTS <br />FIRESPPINKLERRFOD RF4FON <br />IYPE OF CONST P�M1S 1 <br />U4TE <br />HEATING SYSTEM: f 1 GAS fl ELECTRIC f�l <br />COYTACT PERSON FNO PHONE NO. <br />C��� 4 1`1� �h c_�� (Zoco 1�'13 —��.S O <br />I HEREBY CERTIFY THAT I HAVE READ AM1D 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 DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATIIJG CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />x� " .�.,."., ,��fr—�_,��y� <br />51 NRTURE DATE <br />�n.�aZ <br />CIN BUS�NE55 LICENSE NO <br />NO. TYPE OF EOUIPMENT FEE <br />A/C — A/HNDLG UNfTS — H.P. <br />FORCED AIR SYSTEMS — B.LU. M E.A. <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYER� <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD I <br />FIREPLACE INSERT (WOOD <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />PIANCNECKNII!d0[R FEE INECEIPTNO. <br />SD.S D(o <br />VACANT $!7E �c�� <br />f1VE5 fiNO pWL�ING <br />SIZE OF BIOG?I — <br />PLUMOING <br />BASEMENT M[CIIANICAL <br />f1vE5 f! NO <br />ADOIIIONOL PI�N CMFCN <br />OTHER <br />STAIE OUILORIG SUf1C11ARGE <br />CITYOFEVERETT rimiir,wonKs <br />LOCAL SALES <br />TAX CODE IS 3105 TO7AL <br />