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l�lPPLICATIG.J FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />.i200 CEDAR STREET • EVEREIT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION O B�NG ❑ MECHANICAL ❑ PLUNiBING ❑ SIGN <br />PROJECT/lDDRESS: <br />OWHER MeILADDRE55 CITV $IP PHUN[ <br />%%��/�� �r'/'r�+rS 73L%� Lol�lCv.Pr.�� �D cc�C'✓�%/ -�/g7cti3_ � �-1'^'�'�„' lo <br />TENANT MIJI.AO�RE55 CITY 71P P�IONE <br />ARGHITECT OR DESIGNEfi M�IL �UOItE55 GITV 7ip P1/0NE <br />� • <br />GENNERRICONT 11�Tdi MULAD�BE55 CIfY 21P PIIONE SUTEUL[N5�) <br />/ a � ��rriyrs //2i7 marssrr,c 1�S�.es�*-. %&eS`j' ,�.�5�iZ6Z %1'oi'��i6/2 /�o <br />ECN�NIC.�LONTRAC�OR MAIUDDFE55 CITY pIP PIIONE STATE LICENSE � <br />PLUMBINGCONTRACTOR M�ILADDRESS CIIV ZIP PMONE STATELICENSE• <br />DESCRIBE <br />LEGAL �ESCRIPTION OF PROPI <br />l0T 1� BLOCK <br />p6 �� y�/v <br />fAGEINVOLVEU <br />%.�ri,+��c /'lrr <br />�. <br />(SHOWN BELOW Oil ATfACN TWO COFIES) <br />�s� �,-�.�� 7-�-.�ds <br />PMCEL TAI( I.D. NUMBER <br />�3S'Za o�b 6qa o�/o� <br />CONSTRUGTION LONI LENUEH, ADDRE55. TELEP110NE NIIMBER <br />PLUMBING <br />NO. TYPE OF FU(TURE OR ITEM FEE <br />WATEq CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />_ LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DaAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ETC.I <br />SUB TOTAL S <br />PERMIT $ <br />FOR OFFICE USE ONLY: <br />FAONTSETBACK REAR SETBACN <br />USEZONE n / IOiAREA <br />j�_i <br />HEIGHTLIMITATION � NOOFDWELLING <br />� � UNIf$ <br />HEATING SYSTEM: p GAS ❑ ELECTRIC ❑_ <br />CONTACT PERSONA P E NO <br />%17/�/�� �c� 0� '�.3t/ "1�'Z 6 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIUNS OF LAWS AND ORDINANCES GOVFRNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEFiEIN OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 70 GIVE <br />AUTHORITY YO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW AEGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEHTY TO PER�ORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />X �.��� � z _,�,� <br />SIGN iUHE DATE <br />CIT1' BUSINE55 LICENSE NO. <br />A/C—A/HNDLG UNRS <br />FORCED AIR SYSTEMS <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATERIIEATER <br />WOODSTOVE <br />METAL FIREPIACE ( <br />FIREPIACE INSERT <br />GAS FIREPLACE <br />SIDE SETBACK J PUN CHECK NUMOE <br />� S� � Sa/�. <br />VALIINT SIiE FEE <br />❑YES ❑ NO OUIIDINf. <br />SIZE OF BLDGRI <br />� � s .0 PLUMOING <br />{ <br />BASEMENT � � MEGIIANICpL <br />❑YES �p�FiO <br />AODI IIONRL PLAN CNF.CR <br />on�en <br />STAI[ BUIIDINR SIIRCNAIIGE <br />CITY OF EVERETT ruxiir,wonKs <br />LOGAL SALES <br />TAX C4DE IS 3105 T07n1 <br />SUB TOTAL $ <br />PERMIT $ <br />2�7 OC7 <br />FeF nECEirrNo <br />//S. ?J <br />FEE <br />