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APPLICATIC:i FOR CONSTRUC'ti`DN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />❑ DEMOUTION p COMBINATION ❑ BUILDING p�MECHANICAL ❑ PLUMBING ❑ SIGN <br />RROJECT ADDRESS: {^�,. ���)"7 �G' 6.�._.� -4i- a �. � � �. L„ . G. �e.no 11— <br />f' //"/R � <br />9�20� <br />ARCHIT[GTOROESIGNER MNIADDf1E55 LITY ZIP PHONE <br />GENERALCONTRIICTOR MAI�ApORE55 GTY plP PIIONE SfATELICEN•#� <br />�c �,le,�f',,,.0 2'�1l 153�� fMt SG Sn�l. °I�SZ�iO 3�qld4'� /��,q{�ISG[�$71�C <br />MECNANICALCONTRA TOR MAILADDREf� CITV ZIP PHONE STAtELICENSE� <br />PlUA10INGCONTRACTOi� MAI�AppRES$ CITY 21P PNONE STATELICENSE� <br />DE^+CR10E WORI( AND S7O�U1ARE FOOTA�E INVOWEO <br />�n.�nw�(,� �A/C�t' 2�.f1 �1�I <br />•---����r <br />Iw ISOG s s �'i-- �� <br />PipPO$ED VSE OF BUILDINO <br />LEGAL DESCRIPTION Oi PNOPERTY (bMOM'N BELOX <br />LOT BIOCK OF_ <br />CONSiqIICTION LOIN LENOER, �DDpESS. TELEPHONE NUMBER <br />PLUMBINO <br />NO. TYPE OF flXTURE OR ITEM <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTERS <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN REAR! <br />HEIGNT LIMITATION <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACT PERSON AND PHONE NO. <br />s7o.�a 3�4 hl,c.✓ ?,�(n 335- 4 <br />��II�"�(5 I HEREBY CERTIFY THAT I HAVE FEAD AND EXAAfINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CqRRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING 7HIS TYPE OF <br />WORK WILI BE COMPLIED WITH WHETHER SPECIFIEU HEREIN OR <br />TWOCOPIE51 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOHI2ED BY THE <br />OWNER OF THIS PROPERTY TO PEflFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />SUB TOTAL S <br />FEE S <br />CITV BUSINESS LICENSE NO. <br />� <br />A/C —A/HNOLG UNfTS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />CLOTHES DRVERS <br />RANGEHOOD <br />WATER HEATER <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />SIDESETBACN � PLANCIIECN <br />�ATE <br />FAN <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FEE S <br />iEE — RECEIPT NO <br />LOTARE� VACANIS�TE FEES <br />❑YES ❑ NO Bl11lDINC <br />NO OF OWELLING S'ZE OF BIIXi?.I <br />UNIiS <br />PLUMBING <br />OCCUPANTIO�D BASEMENT MECH�NICAL <br />❑YES ❑ NO <br />REASQY ADDI710NRL PUN CHF.LK <br />OTNER \ � <br />REASpN � <br />$TATE BWlO�N . SIIRCN�RfE <br />PLANSAPP OVEDBY CITY OF EVERE7T ruaur.woaKs <br />�%�-/ LOCAL SALES <br />nnrc i�/7'%��i TAX CODE IS 3105 TOTAL <br />FEE <br />