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APPLICATIOt FOR CONST�iUCTI -'N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION p COMBINATION "�'BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTAGDRESS: �� � (1 '� `�=�<n ��'- <br /> 4_�r. �� r -;1HrFl1�'� .i4-' �; F1.... �C� � sl' 'E"f � -� ,-�� <br /> OMmER \ MNL�Dd1E55 C�rv 71r p��pNE <br /> 7ENANT MAIL��DRESS GITY IIP PIIONE <br /> �`,fr�7 .`N.]n 2.� <br /> 11RLMITECTOROESIGNER MMLADORESS LIiY 71P PNpNE <br /> �—�,>; i .�;tnm �-1�m��i r l��y •��1i` --c A�E M1 �'v !�L `'1 ��-1:'�� ��,-� �s�aa F'.���CH ie C•�`�/� F <br /> GENEiWGONTR�L70R MAILA�ORESS LIfY IIP PiIONE SfATEIICENSE• <br /> MECHANICALONTP�CTOR M�IL�DDRE55 f.ITV IIP PIIONE STATEULENSE� <br /> _�<-1'':���urc 1 <�Cl Il . (J S r���h�m �h "��5 �"6 3 <br /> PLUAlMG CONTR�CTOR M�IL AOpRE55 CITV ZIP PNONE STATE UCENSE� <br /> � ��.> �Q� <br /> CONTMCT VPoCE OF WORN <br /> /S�J�'� HEATING SYSTEM: ❑GAS ELECTRIC ❑ <br /> OESCRIBE WORN AND$pUARE FOOTAGE INVOLVED CONIACT PERSON ANO PIIpNE plp <br /> ':;i3 � .�. , ;�-3��.�i�nr, � �.Ff? � l �=r ^ . ra � (' •meS <br /> �� � .-�.�r \�'J�1 -t- '.'3- ���i ::�` •5�_ �� <br /> I HEREBY CERTIFY THAT 1 HAVE fiEAD AND ExAMINED THIS <br /> P/10POSED USE OF BUILqNG APPLICATION AND KNOW TNE SAME TO BE TRUE AND COHRECT ALL <br /> ��-� PROVISIONS OF UWS AND OROINANCES GOVERNING THIS TVPE OF <br /> IEG�lOESCPoPTIpJpFp{ppEpry�ypyyHgE�pWpq�nkHryp�pp�Es� �MORK WILL BE COMPUED WITH WHETHER SPECIFIEO HEREIN OR <br /> NOT. THF pRqNTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> wr l 1'j e�ocK ov �� r��` ��"'< <�-l.i qUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGUUTINO CONSTRUCTION OR THE <br /> ~"� • �� PERFORMANCE OF CONSiRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFGRM THE WORK FOR WHICH <br /> < <l • C.'�.� • \l� � C�C1C� - APPUCATION IS MADE AND I COMPLY WITH THE STATE <br /> PAIICEL TA%I.D.NUMBER CONTRACTORS LAW iB27 RCW ANO 296200 WAC. <br /> LONSTNUC110N lOM!LENDER.11Dp{1E55.TELEPIKKIE NUMBER x�� � �/ 1 �I 1 ' (�, / <br /> l0 <br /> l� �lcV��nt}{.,��� r.� .}I� t � SI TURE DAtE <br /> ,J <br /> CITY BUSINE55lICENSE NO <br /> P����� MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATEq CLOSET(TOILET) � NC—/VHNDLf3 UNfTS � <br /> BATHTUB ; FORCEDAIRSYSTEMS � <br /> UVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWEq � UNITHEATERS � <br /> _ _ KITCHEN SINK 8 DISP ; CLOTHES DRVERS ; <br /> DISHWASHER � RANGEHOOD , <br /> LAUNORY TRAY ; WATER HEATER � <br /> CLOTHES WASHEH � WOODSTOVE , <br /> URINAL � METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN ; FIREPLACE INSERTpMpOD BURNING) ; <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW pREVENTERS ; GAS RANGE � <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING , <br /> ' EXHAUST FAN � <br /> � , <br /> � � <br /> � , <br /> � , <br /> � , <br /> SUB TOTAL S � SUB TOTAL f ; <br /> PERMIT S � PERMIT S � <br /> TOTALFEE S ,i ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAq SETBACK �� SIDE SEiB�CR PI�N CUECK NUMBER !EF OQ REf.EiPi NO <br /> Zb �S � � r , ,jQ �30 � <br /> USEZONE - I LOTAREA VACANTSIiE �� FEES VALUATION FEE <br /> ��� ❑YES .iSNO BNtUINC � <br /> HEIGNTLIMITATION NOOFOWELIING 512EOFBL06RI <br /> i <br /> 2 UNIIS <br /> 8 � 3Z0 _/ V111M01NG � <br /> !! <br /> GCC�UPNCY 1q(ItSi(NtlES OLWPANTIO�D BASEMENT � <br /> J � MECHeNIC�L � <br /> 1 ❑YES �ip � <br /> FlflESPflINNLEflNEO'D RE�SON �ODI710NALPUNLNf.CN � <br /> OillEn � <br /> FIRENARMREO'D REASON � <br /> � <br /> $iAIE OUIlDIN6511fiCH�IiGE T�n <br /> /� �T_r i <br /> TYPEOFf.ONST PlANSMPPOVEDBY CITYOFEVERETT �11911CWOf1NS �j=� /(/n/` � <br /> J�'� LOCAL SALES '� � --;— <br /> � OATE o/'3�5'(� TAX CODE IS 3105 TOTAL - <br /> 21� ,.SU <br />