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APPLICAT'1� N FOR CONSTRUC JON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8010 <br />p DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESSi'I, 825 Lombard Everett, WA 98201 <br />Gverett Communitv ,Co17.e�e 801 [1eCmor.e Gverett WA 98201 388-9513 <br />OWNER MRIIAUDRE55 LITY 21P PuON[ <br />IENANT MFII.AOORE55 f.IIY 71P PIIONE <br />ANLNITELTORO[SIGHER M�II�II[llIE55 CIiY I�P PIIONF. . <br />GENEfiAL GOIIIMGTOfI MAII AOORE55 <br />MELHANICaLCOMRAG70R 1A�IlA��RE55 <br />Pl11MBING CONiP�f.T0f1 MAII AOORE55 <br />GONIR�Cf PRICE OF WOON <br />OESCRIBE WORN eN0 SOUeRE FW GGE INVOWEO <br />Mv <br />PROPOSED USE OF BUILDING <br />ri <br />c/ i <br />IEGAI OESLPIPTION OF PflOPERTY �SIIOWN BELOW OI7 ATTALII T WO COPIES� <br />im mceK or <br />5938 163 013 0007 <br />PMGEL TA7f I.O. NUMBER <br />CONSTPOCTION LOAN IENDER. AOORE55. IELEP110NE NUAIBEf1 <br />OR ITEM <br />WATER CLOSET (TOIL <br />BATNTUB <br />LAVATORY (WASH DA'. <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNORYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FUUNTA�N <br />FLOOR DRAIN <br />BACKFLOW PREVENTEFS <br />SINK ISEHVICE — BAfl. El <br />FOR OFF!�E USE ONLY: <br />iRONTSETMCK PEMSfTOACK <br />QIY J�I` <br />citt 1m <br />CIfY 211+ <br />FEE <br />SU6 TOTAL S I � <br />PERMIT S �—i <br />TOTAL FEE 3 �—' <br />SIDE SEiB�CN <br />1'l10Nf SIAIE IIC[NSE � <br />PIIOn[ STA/E UCENSE � � <br />PIIONE STAiE UCENSE � <br />NEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONT�CT P[RSON AN� PIIONE NO <br />Mark Stewart 3fl8-9513 <br />I tiEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND HNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND OFlDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED NEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTfiDIiI7Y TO VIOLATE OR CANCEL TNE PROVISION OF ANY <br />OThIER SlATE OR LOCAL LAW flEGULATING CONSTRUCTION OR THE <br />PERFC3RA7ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TViIS PROPERTY TO PEfiFORM THE WOHK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS I.AW 18.7 N 296200 WAC. <br />x �161 � ,l' c.�k� �, 5/16/97 <br />SIfiNATl1RE D�TE <br />CITV B1151NE551 IC[NSE NO <br />NO. I TYPE OF E�UIPMENT <br />rvi. — rvnnuw urvu a <br />FORCED AIR SYSTEMS ; <br />i <br />HEAT PUMP � <br />UNIT IIEATERS ' <br />CLOTHES DRYERS i <br />WATER FIEATER i <br />WOOD STOVE _ �—_ <br />METAL FIR[PLACE (WOOD BURNING) ; <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />[�IIAUST FAN <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE E <br />rieHeuecKr�uunrn Ir[r IREf.EIPiNO <br />� ��% <br />USE SONE lOi ARFA VACANI SIIF. 1'CCJ _ <br />❑YES ❑NO 011I1IlU�. <br />IIEIGIIi LIMITATION NO OF ��'ELLING 512E Of OIDORI <br />UNIf$ Pl11M111N(i <br />OCCUPFNCV NO Of SIDNCS OCCUPAHT LO�D B�SEA1ENf IAFCIIANif.�l <br />Gf�OUP <br />❑YE$ ❑NO __—___—__--_ <br />Flf1E5PflWF1.EflflE�'D RFASON e0f1Il1�HAI PI�NCiIff.N <br />__ _ —____. <br />Opl[11 <br />fIREAlAP1.l0E0'� nFeS�N --_'_"_--..__'""'._— <br />tilA1l Illltlliltlli }IIIIIlUI1Gl <br />_____ _ — <br />_-____._ _.._._ —___.. __'_—_ _ <br />�rrenrr,ous� rinns�rrnuvt�nnr CITYOFEVERETT i'��������w����^`� <br />LOCALSALES � � � � -- <br />_�,,,�i TAX CODE IS 9105 TOTAL <br />