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APPLICATIO+ FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •257-8810 47-r <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING rl MFcuANICAI I . _./._.. <br />_.—_....... <br />PROJECT ADDRESS <br />IZoS /_-'ve,edF 1,74e[ we 11 D <br />OWNER AOD ESS CITY ZIP PHONE <br />iENAlli <br />�QO lore L <br />ARCNRECT pI pESGNEfl / <br />ILWIADMESS <br />De5 �E <br />YA1LAOpgE55 i <br />Be(fe V.e.. <br />an <br />/ZOS EV fF <br />GlY <br />1.,-A <br />SP <br />MA <br />ZW <br />W <br />yiY- <br />PIpNE <br />r /( <br />/ plpllE <br />Ss 7 1719 <br />G J:ERALCONTRACIOR <br />FIE�C11A eea ro.P✓ <br />ARK COHTRAGTpq <br />WlA00RESS <br />Ro /3. <br />MAEACORESS <br />CITY <br />[,.. <br />CITY <br />ZIP <br />58av[ <br />ZP <br />Pllq¢ STATE UCENSE1 <br />4zr-�z6-88s <br />PIICNE STATE tICE�EF <br />PLUMBING FgNTgACTWI EApDRE S CRY ZP PHONE STATE LICENSE <br />CONTRACT PRICE OF WORK <br />b S o . ° ° <br />HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br />DESCRIBE ANU 60UMEFOpiA0E NU0.VEp <br />s-/aUIa �'eV./ <br />c< ./•(.� <br />�/6' SUCH 3SI <br />7-F <br />HY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PRDPOEEp usE OP eunnlNp <br />relA. <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGALDESCIIPTpNOFPROpEgry ISNOWN SELryryTRAjTALq jWYT Opp1E5l <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK D<____— <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION <br />OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />'Set S /A.� <br />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 1 COMPLY WITH THE STATE <br />rARcet rAK m. FAIMBER <br />CONTRACTORS LAW 18.27 RCW AND 296. 00 WAC. <br />7 9°S- H- o yZ - o ooS <br />/ <br />CONSTRBOfgN IO.W LEWEA ADORES$, TELEPHONE INMDER <br />6KNAN / <br />E MTE <br />OZL/ 78(. <br />CRY BUSUIESS OCENSE W.. <br />PLUMBING <br />MECHANICAL <br />NO.00WASHBASINI- <br />PE OF FIXTURE OR ITEM <br />TYPE OF EQUIPMENTOSET(TOILET) <br />A/C—AMNDLG UNITS <br />FORCED AIR SYSTEMS <br />(WASH BASIN) <br />HEAT PUMP <br />RFEENO. <br />UNITHEATERSINK <br />A DISPCLOTHES <br />DRYERSER <br />RANGE HOOD <br />TRAY <br />WATER HEATER <br />WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />I <br />GRINNING FOUNTAIN <br />FIREPLACE INSERT 1WOOD BURNING) <br />I <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />I <br />I <br />I <br />i <br />1 <br />SUBTOTAL S <br />! <br />SUBTOTAL S <br />i <br />PERMIT S <br />PERMIT S <br />i <br />TOTAL FEE S <br />I <br />TOTAL FEE S <br />! <br />FOR OFFICE USE ONLY: <br />FRONT SETEACK <br />REARSETRACK <br />SIDE SETBACK <br />NUM R ^ <br />' qo <br />FEE <br />. <br />RECEPTNO, <br />USEZONE <br />HEIGHTMMITA.KIN <br />LOTAREA <br />VACANT ERE <br />DYES ow <br />FEES <br />VALUATION <br />FEE <br />NOMOWELLWO <br />8ME 11F BIDLEL <br />OCCUPANCY NO01610N[S <br />GROUP <br />OCCUPANTLOAO <br />BASEMEM <br />MSURC�, <br />CITES Ow <br />FIRE SPRINGER REOD <br />REASON <br />LAN CHECK <br />— <br />FMEAIARMRE00 <br />MA9pT1WB <br />SURCHI.RGETYPE <br />OF CONST. <br />"s BY <br />ITY OF EVERETT <br />s <br />/ <br />LOCAL SALES <br />TOTAL <br />PATE <br />TAX CODE IS 310E <br />