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APPLIrATI(- �V FQR CONSTRUCI �ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEQAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ OEMOUTION ❑ COMBINATION ❑ 6pUILDING c�MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS:�� ��� �a F? I ;�i Il C' l�i-��%r�4�� <br />�RCMTECT OR OESIGNER <br />6E Rµ COfiTR�C�OR <br />MECNAMCALCONTRAC OR <br />PLl�MOING CONTRACTOP�— <br />CONTRAGT PipCE OF NqRK <br />OESCiNlE WORN AND SWIIRE <br />� � �� �(1 -%�, <br />�� <br />vnocoseo �se os auadr+a <br />LEWL OESCRIPTION OF PROPF <br />lOT _ BLOCK <br />��T,��.�.��py <br />� <br />CONSTfM1CT10N lOul LENDEN. <br />M�IL I�WRE55 ��/-I�IY" <br />i-�L�A ' �Z %��!1''1 �1y� y..1� <br />MAIIADDR 55 (;�ry <br />���1E. <br />M�IL�DURE55 � Cltt <br />��\ 4 <br />(OQ% • <br />TM.E INVOLVED <br />,... .�-�•-- �--- <br />TELEP110NE <br />PLUMBINO <br />NO. TVPE OF Fl)lTURE OR ITEM <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINN 8 DISP <br />DISHWASHER <br />IAUNDRY 7PAY <br />CIOTHES WASNER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SEFVICE — BAR. ETC.1 <br />FEE <br />SUB TOTAL f <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />iRONTSETA�CK PEMiSETBA�R <br />USEZONE IOT�REA <br />HEIGHTIIMITAT10N NO OFOwELLING <br />UNIf$ <br />OCCVPANCY NJ M SI(vbCS OCCUP�NILOAD <br />FIRE MARM AEO'D <br />ninNs errnoveo nv <br />U�iE <br />9DE SETB�C1c <br />71P <br />���' �'MONE <br />� � �?_ �( -l0 d <br />� <br />P�.• / L+ 1 1 b V i 1 �/ 1 l�_I l//� l!I i <br />2iP � PMONE ST�TE ULENSE � <br />ZIP PHONE STQ[ LICENSE � <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ��"F'-(i F't l�i <br />CONT�CT PLRSONAND PNONE NO �' <br />/_y A � E{ Yz{��.� 1r � <br />79 2 - ��.rtn r, <br />I HEREBY CERTIFY THAT I HAVE READ AND 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 'NITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTINQ OF A PERMIT DOES NOT PRESUME TO GIVE <br />..UTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REQUUTING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTMORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS 1 COMPLY WITH THE STATE <br />CONTRACTO A A D 296200 WAC. <br />x lC� l� Jr <br />SiGN�TURE D E <br />CITY BUSINE55 LICENS[ NO. <br />MECHANICAL <br />NO. TVPE OF EQUIPMENT FEE <br />wc — wnnuw unu � <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />WWGE HOOD <br />' MEfAL FIREPLACE � <br />i FIREPLACE INSERT <br />� GAS FIREPIACE <br />; GASRANGE <br />� GAS PIPING <br />0 <br />SUB TOTAL S ' <br />PERMIT E —i <br />TOTALFEE E ! <br />PUNLIIECKNUMAEII IfEF InECFIPiNO <br />��C�Nt SITE tttD <br />❑YE$ ❑ NO OUIl01Nf. <br />SIiE OF OIDGRI <br />PlUM01NG <br />BASEMEN� MECII�NIUL <br />❑YES ❑ NO <br />ApD�fIONAL PLAN C��CCK <br />0111ER <br />SiqE BUIl01Nf SURLMAf1GE <br />CITY OF EVERETT runncwonKs <br />LOCALSALES <br />TAX CODE IS 3105 70TAL <br />