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APPLICATION FOI� CONSTRUCT�ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISIOR � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />fl DEMOLITION T�i'COMBINATION f l BUILDING f� MECHANICAL � l PLUMBING f l SIGN <br />PROJECT ADDRESS <br />�6 iz 1✓,,.. �- !J✓� � . _ _ �- , .,ti <br />OWNER <br />C�TV <br />PHOUE <br />Jo_ <br />�trvwNl MpILROCRE55 CITV lIP PIIONE <br />1�n n!C- <br />AA�����ECT OR DESIG�J[R MAIt pDORE55 GITV )IP PHONF <br />f,OYTR�CTOR MAIL <br />zir <br />� <br />SiATE f ICENSE � <br />- w � �c .i_vc�ieP��- Zo.c!/.� V/.)JC(f ���N/ <br />MECHANICFLCONTq�CTOR MAILq0�RE55 CITV 21t' PIIONE STATEUGENSE• <br />�S�- 37 � <br />PLUMBINGCONiRAf,TOR MAILAODRESS CIiY ZIP pHONE STAiELICENSE� <br />LpNTRqCT PPICE OF WORK <br />�(on, noc, <br />�ESCRIBE WORK AND SOUARE FOOTAGE INVOLVEO/ <br />W�RE� PlNM6� G/�PPfsrCYl� /i <br />L(�s�a�as �rv.,�� �.a,on- �N SlF<� <br />�('] .�MC�IPf.� u � Ii�!'L /9/L'D RPC` %dY� <br />PPOPOSED USE OF BUILDIN(37— <br />ia�,,.s,��,,,,n � �ousi:vs <br />LEGAL OESCPIPTION OF PROPERtt� (S7HOW ELOW OR PiTA <br />LOT �� OLOCN _�_ OF� <br />��/l i�','K.P 6D <br />PAFCELTA%ID.NUMBER <br />CONSTqpGT10NLOPNLENpER.�A,qDRESS.TELEPHONE NUMB <br />e, �-� o � E✓r.�eTl"' �! N7'r7- ,Lo� <br />/ <br />�/__,.,.:,� .�.,,f_ �� <br />NO. <br />BATHTUB <br />LAVATORY <br />SH0IVER <br />OF FIXTURE OR ITEM <br />8 <br />LAUNDRI'TRAY <br />CLOTHES WASHER <br />URINAL <br />Dr71NKING FOUNTAJ <br />�' ona naa� <br />— BAR, <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTAL FEE $ <br />HEATING SYSTEM: �GAS f 1 ELECTRIC fl <br />CONi/ CT PEBSON r1N0 PHONE NO <br />�'lr�an�.aiv I%.cc.�PN � .�5�'.��77 <br />J/H/Y �V � � SJ S' (D / / / <br />I HEREBY CERTIFY THAT I HAVE P.EAD AND EXAMINED THIS <br />APPLiCATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAVJS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE GOMPLIED WITH WHETHER SPECIFIED HEREIN OH <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GNE <br />AUTHORITY TO �IOLATE OR CANCEL THE PRnVISION OF ANY <br />OTh�R STATE OR LOCAL LAW REGULATING CONSTRUCYIOPt OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEJ BY THE <br />OWNEfi OF THIS PROPERTY TO PERFORM THE WORK FOR WHICN <br />APPLICATION IS MADE AND I COMFLY WITH THE STATE <br />CONTRACTORS LAW 10.27 RCW AND 296.200 WAC. <br />x �,� 4? . �n�-�,�s <br />SIGNATUR�C DATE <br />CITY BUSINESS LICENSE N0. <br />NO. TYPEOFEOUIPMENT FEE <br />A/C — A/HNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP � <br />UNIT HEATEFS — B.T.U. M <br />� CLUTHES DRYERS <br />VENTILATION FAN <br />RANGEHOO� <br />� WATER HEATER <br />METAL FIREPLACE I <br />FIREPLACE INSERT <br />' GAS FIREPLACE <br />GAS RANGE <br />I GAS PIPIN <br />FOR OFFICE USE ONLY: <br />FRONTSFTPACN RFMSF.TBAG SI�ESEiDACH PI�NCIIECKNUMpFQ� <br />/ <br />� J� <br />USEZONE IOfr1R[F VRCANiSRE FEES <br />IiYES fl NO <br />— OOLL�ING <br />NEIGIrtIIMItAiION NOOFOWEIUNG 512EOfpLOG,TI <br />llNliS <br />NO OF SIORiES pCCUPANi LGi <br />2 2G� <br />on nr�n,syo,u <br />� L'F!�%/�:� <br />aneon arncom - <br />' ��(/ ^f' vtun+owG <br />I <br />ASEMf:NT MEGIANICAL <br />vF5 I I NO <br />M1�OI110NPI. PI RN GIF.CN <br />C7Y�E`� GT �/�i�/ on�En <br />s*aie euiiowc sunamnce <br />CITYOFEVERETT runiicwor�Ks <br />LOCALSALES — <br />TAX COUE IS 3105 70TaL <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FEE $ <br />FEE I REf.FIPT NO <br />/ <br />