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� ^. <br />APPLICATIOA FOR CONSTRUCT�ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />f7 DEMOIITION fl COMBINATION fl BUILDING f7 MECHANICAL n PLUMBING f-I SION <br />LROJECT ADDRESS I <br />/(o f erl✓ ��. �' UP ►'e �, W�J 5'��0 � <br />OWNER MML�ODRE55 �m� CITY ZIP PHONE <br />�vl;o/D L!3 �2d/e. � v�r�v;�" 9d�o3 35 � � a-�S <br />TENANT M4lMDRE55 QTY ZIP PNONE <br />�RCHITECTOqDE51GNER MAILADDRESS CITY 21P PHONE <br />GENEHALCONTPACiOR MAIL�WORESS qTY ZIP PMONE SiATELICENSE� <br />MECNANICALCONTRACTOR .`A�ILADDRESS CIN ZIP PMONE SUTELICENSE� <br />�W h�'� <br />PWMI�INOCONTR�CTOR MAILAODRESS Cltt ZIP PHONE ST�TELICENSE� <br />ior <br />O <br />�ND: <br />oF anoaerm' <br />_ e�oat _ <br />IENDER. MORESS. IELEPHONE NUMBER <br />NO, TYPE OI <br />WATER CLOSET <br />BATHTUB <br />� LAVATORY (WAS <br />SFIOWER <br />. � �.....,�.. ��.�v . <br />FLOOR <br />OH ITEM <br />SUB TOTAL S <br />� TOTAL FEE S � ' <br />FOR OFFICE USE ONLY: <br />FRpNT SE7BACK PEM SETBACK SIDE SETB�CK <br />USEZONE IOTAREA V�C�NiSITE <br />(IYES fi NO <br />lIEIpHTLIMIT�TION UNITSFDWEWNG SIZEOFBLOGRI. <br />� ��� I I I IlVES fl NO <br />CRY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />HEATING SYSTEM: Zit GAS fl ELECTRIC fl <br />� <br />CONi�CT PERSON �N� PNONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANO 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 ORANTINO OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPEFiTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 298.200 WAC. <br />X '�' �„Q/ G/� .C�����i�-- <br />SIONA E O�TE <br />CIN BUS�NE55 LICENSE NO. <br />AECHANICAL <br />NO. TYPE OF ECUIPMENT <br />A/C — AIHNDLO UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RAN(iE Fi00D <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING <br />FIREPLACE INSERT (WOOD BURNINf <br />1 GAS FIREPLACE <br />PIAN CNECK NUMBER <br />BUILDING <br />PLUMPING <br />MECNANILAL <br />PDDITIONAL PLAN W�F.CK <br />OTHER <br />$TATE Bl11LDINC SIIRLHAq6E <br />PUBIIC WORKS <br />TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />fEE RECEIPTNO. <br />