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APPLICATI00FOR CONSTRUCT& PERMIT <br />CITY OF EVERETT • BUILDING DIV!SION <br />3200 CEDAR STREET • EVERFTf. WA 98201 • 259-BB10 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ® PLUMBING ❑ SIGN <br />PROJECTADDRESS: LIOa. SE CVc+cT< Mo.0 lu° <br />OWNER ALL ADDRESS V" :Ir rrgrrc <br />rEx+1xr1 MARLADURESS ary im — NIONE <br />�oTtCtO �J0. utf <br />�♦nua.RlRcr on Dfslcxrn MuI .DDnfss ory nr RIGNr <br />REN[MECO.I.AC10R MULACDRESS CITY Irr MAXIE SIAIEUKTNSEr <br />/i. Kcvl alv°r °n 1 c 44dok'—') r1..sRsfc! �cslN.eHc( y&o5a <br />u[^.N+xICAI CONTGACIOM A't AOOPESS CITY lip RIWf SMTE t4EMSEA <br />PUIMBNO CONTRACTOR MULADDRESS CITY PIP N"E STATE LICENSE <br />Lu IliaL Ada nc / 1(, 4,ri-lIj Ave a gf037 77 $Gd7 GMIl7 xAT //9L7 <br />cannACT rn¢f D M K <br />3N 1 Ly eO <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CCscmnf Y�;I(ANOSWAnM FOOrAGE Uiv yfO <br />NLRA L..bi�q <br />canACrr[n$ONANO Rg11E VO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNON THE SAME TO BE TRUE AND 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 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 REGULATING 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 COMPLY WITH THE STATE <br />CONTRACTORS LAW S�IB 27 RCW AND 296200 WAC. <br />X 9 !, - <br />RRDrosEO a BUIONO <br />G� I <br />LfmLT1ESCDrrgNa RgRnry ISIKTN'N BELONOTAn.cN tsYD canfsl <br />LOT BLOCK ar <br />P=tt'AKIn 1uMBER <br />COKSTROLnGK tom LENDER. ADDRESS. RLERKXNE NUMBER <br />SKA 1Di O.IE <br />�� <br />LILY BU91£SS IK;ObNO <br />NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />_ <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />7�AIC—A(HNOLG <br />UNITSWHNOLG UNITS <br />FORCED AIR SYSTEMS <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC.) <br />7 00 <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMIT S <br />Q <br />PERMIT f <br />TOTALFEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />RDINT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />RANCUECK NVMBrR <br />IIt <br />RECEIPT NO <br />USE:OAE <br />IDrAREA <br />VACANT SITE <br />OYES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />MAI IMNR <br />HFIOITUATATION <br />AD aOwELUG <br />UN115 <br />BARE OF BLIXRnI <br />RVUBRN(1 <br />MFLII.NN',Y <br />OCCU]ANCY <br />GITO N <br />N]DSTMES <br />OLCUPANr IOKO <br />BASEMENT <br />❑YES ❑ ND <br />R <br />AOOIKIx.I RCN DYf.K <br />fIPf SRUNKLfRPEOD <br />REASON <br />OTHER <br />PIKE ALARM RED <br />REASON <br />STATE BIMDN09ACIIAROE <br />TYPE Or r.ON51 <br />rtnxs APrnovEn DY <br />DME <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />Rral r. vnvRKs <br />TOTAL <br />-- <br />