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APPLICATII.��I FOR CONSTRUCZ _�N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />f7 DEMOLITION fl COMBINATION BUILDING Cl MECHANICAL f l PLUMBING (-I SIGN <br />PROJECT ADDRESS <br />"7l ;y' S'` EUL112L• Pr ����� w���P ��v�-72 �; � <br />OWNER MAILA�DRE55 CITV ZIP PHONE <br />S�.Qr c���►J Sz� 9lsr �v� �vc= �=ur�c:,! U,� qs2�� 33S-y5C;v <br />1ENANT MFILADDRESS CITV 21P PHO�JE <br />ARCHIiECTOR�E5IGNER MAILAODRE55 CITY 21P PHONE <br />� o��,� �32y/��,r 353-�? 3•i <br />MAILPUUIIt]] <br />NUVMtJ] <br />� <br />�__r___."_......._._.� ...................... <br />b�CONT CT PRICE OF WORK <br />OESCRIDc WOflK ANO SOIIAPE FCOTAGE INVOLVLD <br />�2-er-��c,� t3u�-t���� <br />USE OF BUILDIN� <br />BELOW OR ARACH TWO COPIES� <br />LOT BLOCK <br />PAPCELTAXI.O.NUM�ER <br />CONSTRUCTION LOAN LENOER, AODRE55, TELEPI IONE NUM�Efi <br />PLUIWBING <br />TYPE OF FIXTURE Oa ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASFI BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER � <br />URINAL <br />DRINKING FOUNTAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ET <br />uir Zlr <br />CITY IIP <br />CITV ZIP <br />FEE <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FFi0Ni5ETBACK REMSETFACK SI�ESETBACK <br />USEZONE LOTAHEA VACANTSIiE <br />f7YE5 Il NO <br />HEIGMT LJMITATION NO. OF DYIELLING 512E OF BLDG/T.I. <br />UNITS <br />OCCUPANCY NO.OFSTORIES OCCUPAN"LOAD BASEMENT <br />GROUP <br />❑YES ❑ NO <br />PNONE SiATE LICENSE u <br />PfIONE STATEUCENSEM <br />PHONE STATE LICENSE d <br />HEATlNG SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACT PERSON �NO PHONG N0. <br />I HEREBY CERTIFY THAT I HAVE REl�D AND EXAMINcD THIS <br />APPLICATIOtJ 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 WHETHEq SPECIFItO 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 LUCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY'i HE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MA4E AND I COMPLY WITH THE STATE <br />CONTRACTORS I W�7 RCW AND 296200 WAC. <br />X / �e�1en-� 2/LZ/9� <br />SIGNATURE UATE <br />CITY BUSM[SS I.ICENS@ N0. <br />NO. TYPE OF FI%TURE OR ITEM <br />A/C — A/HNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS -- B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE i <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS PIPINC <br />EXHAUSTFAN <br />BUILDING <br />PLUM�IN� <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE OUILDING SUACHRRGE <br />imevrwai. rumo rr'wtum CITYOFEVERE� PUBLICWORKS <br />�� �� LOCAL SALES <br />DATE i- � 1- 9 S TAX CODE IS 3105 TOTAL <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE $ <br />�@E RECEIPT N0. <br />FEE <br />' - <br />� <br />