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o • <br />APRLICATION FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOUTION rl COM8INATION Cl BUILDING I-1 MECHANICAL �l PLUMBING �OQ SIGN <br />PROJECTADDRESS ��/� �� ,f✓.ii+ -23,i <br />6oZ0 SE �Ve�e7�7� _ <br />ARf.HITECT OR <br />N 5.11/6as�j ZIP �� PHONE <br />(I <br />��Ty 21P PHONE <br />an zm <br />GENERALCONTRACTOR MAILAODRESS GIIY 21P PH04E SiRTELICENSE• <br />lroa�e.�- �-�Yee �e,!✓ //3.t5/ M.k•Ifcv .�d�✓ /�'l�k;/ho 9g.2).f 353=or,25� T.)"t�kee�'Aog <br />MELHA ICAL CONdTR,ACTOpR MpIL ADDRESS CI � ZIP P��ONE STATE UCENSE � �� <br />N//� <br />PLUMBING CONTRACTOR MAIL AODRESS Lltt ZIP PHONE STATE LICENSE • <br />,..,......._.....__ �./Y� ao <br />OESCRIBE WOFK AND SOUARE FOOTRGE INVOWED <br />�i►sf•..il oit e s�4�/s - �{',ce � <br />n,o�fzd 53� C �G "x�y'i <br />PROPOSED USE OF BUILUING <br />LEGAL �ESCRIPTION OF PROPERTY (SHOWN BELOW OF ARACH TWO COPIES) <br />LOT BIOCK OF <br />PARCEL TA% I.D. Nl1MBER <br />CONSTRUCTION IOPN IENDER. RODRE55. TELEPHONE NfIMBER <br />� TVPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOW ER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />L4UNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLUOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETCJ <br />SUBTOTAL S <br />PERMIT S <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />PRONT SETPACK PE�R SFTBAG% <br />USE ZONFj� ^/ � lOT RREA <br />�J <br />HEIGIITLIMITRTION UN'OFDWELI.ING <br />RE00 <br />SIDE SETBACN <br />HEATING SYSTEM: fl GAS �l ELECTflIC f-1 <br />CONTACT PERSON ANO PHONE N0. <br />�r.� 3ss- � s�.�y <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 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 B'V THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I CUMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 R AND 296200 WAC. <br />n <br />��'�yyr� `�^S'�96 <br />x DATE <br />SIGNATURE <br />CITY BUSINE55 LICENSE N0. <br />TYPE OF EOUIPMENT � FEE <br />�LU urvl l D — n.r <br />SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />UNITHEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WOOD STOVE <br />METAL FIREPLACE i <br />FIREPLACE �NSERT <br />GAS FIREPLACE <br />GAS PIPI� <br />EXHAUST <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />PLANCIIECKNUMOFR I FEF � � n I �ECEIPiNO. <br />VNCANt SIiE <br />( � YES � � NO OUILOING <br />SIZE OF BLDGRI <br />PLIIMOING <br />BASEMENT MECHnIaCAL <br />f1YE5 fl NO <br />ADOI110NA11'I �N G�fCK <br />OTHER <br />STNE OWLDING SIIRCH�RGE <br />CITY OF EVERETT runur,wo�Ks <br />LOCAL SALES <br />. TAX CODE IS 3105 TOTAL <br />FEE <br />