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APPLICAT14�1 FOR �ONSTRUC7.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />fl DEMOLITION fl COMBINATION I�I BUILDING fl MECHANICAL � 1 PLUMBING fl SION <br />PROJECT ADDRESS <br />33oS- Fe,a��� �✓� , �v�n�� <br />ER MALAODRESS CITY pIP PNONE <br />JERIcy ,(��ccY S"sos•.Zis� sf Sc� m�T. ccJ.�. 9�0�.3 ��e'- �f9o7 <br />TENANT � MqILAf70RES5 f.ITY 21P PHONE <br />�RCHITECTORDESICaNER MI�UDORE55 LITY ZIP PHONE <br />CIiY ZIP <br />r <br />Y�iUrvG STRiE LICENSE � <br />PLUMBIN6CONTPACTOR MMLAODRE55 CITv ilP PHONE STATELICENSE� <br />GONTIUCTPPoCEOFWORI( i//���� <br />tia� <br />� �t,i <br />DESCPoBE WORK AND SOUARE FOOTA6E INVOWEO <br />rN%zio2. %��r,o,o�C //�Rvo� <br />�c�� oescmrnow or crroreRn �sirowN ee�ow «f+�n�cn <br />l0T � BLOCN � OF ` V f <br />Y3�S-�ds- ao3 -0000z. <br />rN+ce�T�zi.o.Nur�een <br />CONSTRUCTION LOAN LENDER. ADdiESS. TELEP110NE NUMBEfl <br />PLUM&Nfi <br />NO. TYPE OF fl%TURE OR ITEM <br />WATER CLOSET (TOILEn � <br />� BATHTUB '� <br />LAVATORY (WASH BASIN) �� <br />SHOWER <br />KITCHEN SINK E DISP � <br />DISHWASHER <br />LAUNDRYTRAY ' <br />CLOTHES WASHER <br />URINAL <br />�RINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERViCE — BAR, ETC.) <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRdJTSETB�CK REAqSETBACK <br />9 A � 9 .-� � <br />USE ZONE <br />HEIGNT LIMIT�TION <br />'� [! I <br />CJ <br />OCCUPANCY Np Of SI01 <br />G�3 2 <br />�'"/� <br />LOT�REA <br />NO.OfOWELUNG <br />UN115 1 <br />)' 91V <br />F <br />HEATING SYSTEM: '{Cl GAS I� ELECTRIC fl <br />CONTA�T PERSON AND PHON <br />TY_ODIi G//li 'i���Ll/ii <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEflNING THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEHEIN 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 RE6UWTINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />SIGNATU �����tn � �j���� <br />CITY BUSINE55 UCENSE NO. <br />� <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRVEflS <br />VENTILATION FAN <br />WATER HEATE <br />WOOD STOVE <br />GAS FIREPLACE <br />EXHAUST <br />SIOE SETBACN P�AN C11 CN NOMBFP <br />S I � <br />V�C�NT SRE FEES <br />f I YES f i NO BUIIDING <br />SIZE OF BLDGT <br />6 �n�` f'Ll/M61NG —_ <br />BASEMENT � MECHANIC4L <br />f1YE5 KNO <br />ADOIIIONM. PLFN CHF.CK <br />OIIIER <br />STA1 E BUIlO W G SURCHMGE <br />CITY OF EVERETT runur, wonres <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FEE il� IRECEIPTNO. <br />