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� <br />APPLICATInN FOR COIdS7'RUCiION PERMIT <br />CITY OF EWERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 25�•8010 <br />O GEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PpOJECT ADDRESS: ��j LO Lp w(r I? r�Q/�L f� <br />, y' � <br />L�b d�vfcnZA- . �nll5- �i�i�ry /�[/Ck/ �_Ynni,�._�-. -�JGi.i/_ 7vc._c��.., <br />TEN�NT M/UlA0DRE55 CITY 71P PIIONE <br />AqCHITECT OR DESIGNER M�II �DORESS �ITY )In PHONE <br />GENERA�CONTRALTOR MelU0URE55 CRY Im PupNE SfATEtIGENSE• <br />MECHANICA� �pNTNACTOH MAIL <br />CITY <br />P/IOVE <br />PLUMBINGCONT!I�CTOR Me1LADOPES$ CITY Z�P PNpNE $TA7ELICENSE� <br />�� /QUV <br />�ESCRIBE WORN AND SOUARE FOOTAGE INVOlVEO <br />��� <br />LEGAL OESCRIPTION OF PqOPERTY (SHOWN <br />LOT � BLOCN <br />CONSTAUCiION LOAN IEN�ER. ADDRESS. TELEPMONE NUMBER <br />NO. � TYPE OF FIXTURE OR <br />WATER CLOSET (701LET1 <br />LAVATORY (WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />CLOTHES WASHER <br />URINAL <br />FLOOR CRAIN <br />BACKFLOW P! <br />— BAR, <br />SUB TOTAL $ <br />FEE <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONT�CT P[RSON AND PHOHE NO <br />I HEREBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS <br />APPLICATION AtJD KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL f3E r,pMPLIED 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 CONSTRUC710N. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />x � /2 3 <br />SIGNATVRE D�TE <br />CITY BU INESS LICENSE NL. <br />NO. I TYP[ OF EOUIPMENT <br />rvi. — rvnnvw vrvn a <br />FORCED AIR SYSTEMS <br />HEAT FUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />� WOOD STOVE <br />' MEfAL FIREPLACE � <br />i Flfl[PLACE INSERT <br />� GAS FIREPIACE <br />; GASRANGE <br />� GAS PIPING <br />EXHAUSTFAN <br />FQR OFFICE USE ONLY: <br />FROHT SETBACK REAR SETBRCK SIUE SETBACK <br />USEZONE <br />NEIGNT LIMITATION <br />OCCUVANCY NO Oi5 <br />GROUP <br />FIRE SPflINKLER REO'D <br />LOTAnEA <br />NO.OFUWELV4G <br />UNITS <br />VACANT SI IE <br />❑YES ❑ NO <br />S12E OF OLDGRI <br />❑YE$ ❑ NO <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE 5 <br />PLANCIIEGNNlIMO� //� I FEF I �ECEIPTNO <br />5��; a <br />OUq�ING � 6d <br />i <br />PlpM01NG <br />� <br />MECN4NILAL � <br />400�IIpN�1. PLAN CMF.CN <br />Ot1�E❑ � <br />i <br />ST�iE OU�IOING $IIfiC1��fIGE �S� <br />-- �— <br />PUOI If. WORRS <br />—i— <br />TOTAL � c�- I SZ <br />