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-�, � <br />APPLICATION FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />I� DEMOLITION fl COMBINATION I� BUILDING �MECHANICAL �� PLUMBIN(i fl SIGN <br />PROJECT ADDRESS ,� � 1 I _ <br />ZIP <br />ARCMTECT OR DESIGNER M�IL �DDRESS Lltt )IP PHONE <br />� <br />Z <br />�t�� RlL—�LLGi�a�����-I�I�.��. <br />PIIOPOSED USE OF BUIIdNb <br />�oa oexmvna+ a vnorenn �s�avm ee�ow on �n�cN Two cov�es� <br />�ar etocn oF <br />PNICEL T/U( I.O. NIIMBER ^ rtt ^ <br />�� 1 ���lJ l lJ� � <br />CONSTMICTION Lf AN LENOER, �OMESS. TELEP1/0NE MIMBER <br />��� <br />NO. TYPE OF FlXTURE Op REM FEE <br />WATER CLOSET (TOILE� <br />BATHTUB <br />UVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />, DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAI <br />DRINKINO FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTERS <br />SUB TOTAL S <br />PERMIT E <br />FOR OFFICE USE ONLY: <br />FRO4T SERI�ICK PE�R SEIBACN <br />USE ZONE t0T �RE� <br />HEIQNT UMIUTION NO OF DWELIING <br />UNIfS <br />FIRE $PRINKLER REO'0 <br />BV <br />$IOE SETB�CK <br />V�C�NT SITF <br />IIYES fl NO <br />(iN PMONE STIITE LIGENSE • <br />HEATING SYSTEM: f�T GAS f�l ELECTRIC fl <br />CONT�CT PERSON ANb PHONF No A . <br />��'►(.P`1-�-�K yl� <br />I HEREBY CERTIFV THAT I HAVE FEAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL @E COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REODUTINO CANSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTMORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM TME WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW iB. . 00 WAC. <br />X �/ � <br />SK3N�TURE D�TE <br />CITY BVSINES$ LICENSE NO. . <br />NO. <br />NC —AMNOLO UNITS — H.P. <br />FORCED AIR SVSTEMS — B.T.U(d`j�A E.A. <br />HEAT PUMP <br />UNIT MEATERS — B.T.U. M <br />CIOTHES DRVERS <br />VENTIUTION FAN <br />WOODSTOVE <br />METAL FIREPLAf <br />FIREPLACE INSE <br />GAS FIREPLACE <br />OAS RANGE <br />PERMIT E i <br />TOTALFEE S ! <br />PLANCIIEGKNOb�R � FF.E � AEf.F.�PTNO. <br />ewioiNr. <br />SI2E pi BLOGrtI <br />PLUA191NG <br />B�SEMENT MECH�NIC�L <br />fivES II NO <br />' AOD1710NR1 C1AN GNf.CN <br />OiHER <br />SiAIE BIIILDING SIIRCNnRGE <br />CRY OF EVERETT rueur. wonKs <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />