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--. <br />At�PLICATI�..�i FOR �OI�STRUC'1.OP! PERMIi <br />CITY OF EVERETT • BI;ILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8i'10 <br />❑ DEMOLITIOfJ Cl COMBINATION 17 9UILDING ❑ MECHANIGAL fl PI_UMBING Il SIGN <br />PROJECT ADDRESS <br />��(�7 Lvw�+ /��� K'� <br />OWNER I1�11LADDRESS CITV ZiP PMONE <br />Job Gr�"�e 7`il7 Go�..,;i �i�qc (<�� �VT. 9y=a3 3S}-9�Y� <br />TENPYT MAILAODRESS � GITY 21P PHONE <br />ARCHITFCTOROESIGNFR M11qILA�DPE55 Citt ZIP PHONE <br />GENERALWNTRPCiOF b:AILA��RE55 C�iY ZIP PHCnE STATELICENSEK <br />MECHANICALCONTR�CTOR MAILRDURESS /� Cltt ZIP PHONE STATELICENSEI <br />/�(�o;�,t�,htc G«s r1�•<{'���S�NC. 3S�S JI�11�.SE, EJt 9SziK" 397��:�97 AFfORGttOS-3i�R <br />PLUMBING CONiRRCTOR MAiI F�D . SS CItV ZIP PNONE STATE LICENSE x <br />CONTPACT PPICE OF W RH <br />��� <br />DESCRI9E WORN ANC SOUP9� FOOTAGE INVOLVEO <br />_ .� � �! Gc�.�.�-� s���� <br />PFOPOSE� USE GF 9l;ILDING <br />LEGAL �ESCRIPTION OF PROPERTV (SHOWN BELOW OR ATTACN TWO <br />LOT BIOCN OF <br />PARCELTAXI.D.NUMBER <br />GONSTqUCTION I.OAN LENpER. PDDRESS. TELEPNONE NIIMBER <br />NLUMBING <br />NO. TYPE OF FIXTURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />7[�Z�7: <br />yi.i ��ya:��i�y� <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE 5 <br />FOR OFFICE USE ONLY: <br />FRONTSFTDACK R[AR SF.T�FCH , gI�TBACN <br />USEZONE IOTAqEA VACANTSITE <br />fl YES [l NO <br />HEIGHT JMITATION NO. OF OWELLING SRE OF OLDGRI. <br />U!:ITS <br />TVPE OF <br />UATE <br />�Y <br />f��ES Il NO <br />HEATING SYSTEM: R GAS ❑ ELECTRIC ❑ <br />CONTACi PERSON AN� PIIONE NC <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 OR�INANCES GOVERNING 7HIS TYHE OF <br />1NORK VJILL BE COMPLIED WITH WHETHER SPECIFIED HER[IN OR <br />NOT. THE GRANTING OF A PERMIT OOES �JOT PRESUAIE TO GIVE <br />AUTHORITY TO VIOLATE OR CP.NCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUl'HORIZED BY THE <br />OWNER OF THIS PROPERTY TO �ERFGRM THE WOF.K FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATF <br />CONTRACTORS LAW 1827 RCW AND 296.200 �KAC. <br />X _C.-1t�/-�'o /�.�eu•�cr � �/ y2 %- `/ 7 <br />SIGNATURE DFTE <br />� ''S � /vC� �� <br />CITY OUSINE55 UCENSE NO. <br />NO. I TYPE OF FIXTURE OR ITEM I FEE <br />A/C — AMNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M <br />HEAT PUMP <br />UNIT HEATEHS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD _ <br />W.4TER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING <br />FIREPLACE INSERT (WOOD BURNINC <br />GAS FIREPLACE <br />GASRANGE <br />GAS F'IPING <br />EXHAUSTFAN <br />SUB TO <br />PERMIT <br />TOTAL F <br />FLAN CNECN NULfpEP I FEE I RECEIPT N0. <br />��/9�7 <br />BUILOING <br />PWN9IYG <br />MECHANICFL <br />FODITIONAL PLAN CHECK <br />OTMER <br />STAT[ OUIl01YG SIIRCMARGE <br />CITY OF EVEREI'T PUBUC WORNS <br />LOCAL SALES <br />TAX CUDE IS 3105 , TOTAL <br />