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APPLICATIL.�1 FOR CONSTRUCI�N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION �3 COMBINATION ❑ BUILDINO ❑ MECHANICAL ❑ PLUMBIN(i � SNiN <br />PROJECTADDRESS 2102 Nl�'/���}r,o �7cf fy,C'�LkT�– <br />dV <br />OYYnER MNL�DDRE55 CITV IIP V PMpNE � <br />L/1(�/R�r'�f�dEAar/E NA43�S✓ 2i31N�LN�A,o�h.�` EZ?',�,Fir94ccr �st�94So <br />7ENIINT MIUL�DORE55 CITY ZIP PHONE <br />Sits,E <br />MMMTECTOROESIONER /MILADORESS CITY ZIP PHONE <br />I✓��6�v ��sr icSL N�Fr+c.rro t'�T. ZJ1-1vs� ��rc�t3o�� <br />OENEfULCONTPACR7R MAILII0DRE55 G.TV 21P PHONE ST�IEUCENSE� <br />MECMAMCKCONTRACRM MNIMdiESS CITV ZIP PMONE STATEUCENSE� <br />PLUMBM6CONTRACTOR MAILADOHESS CITV ZIP PHONE STATEUCENSE� <br />DRt�(C f.A�. E.f 3 II �hr �ti�^T 21'9n9 kU pA�i�'S .s �B <br />ca+rn�cr v� a wanc <br />�S�l °'�O HEATING SYSTEM: ❑ GAS dYELECTRIC ❑ <br />oescniee wor�c uro sou�ae worrae n�vavEo <br />Aea oN L� sr°�r To <br />70P�[F.4i /UY�s'� Ff <br />��/ctk 3ov° sa fr <br />vr�ovosEo use oF eimumo <br />� - o�pc EXi'r�" <br />1E0111 UESCRIPf�ON OF PROPEiRY (SNOYVNlE�OY <br />�or (�($_ ewac �1.�� oF. <br />vsZF% <br />� <br />S632-y.S3—o�9—a��� <br />�R. AODRESS. TELEP110NE NVIABER <br />�V�� <br />� NO. TYPE OF 1 <br />- WATER CLOSET (1 <br />BATHTl1B <br />IAVATOP� �vYASH <br />4 SFIOWER <br />, Z KITCHEN SINK 8 [ <br />DISHWP 3HER <br />IAUND�iY 7AAV <br />� CLOTHES WASHE <br />URINAL <br />FOR OFFICE USE ONLY: <br />FRONT SE7B�CK / iIEM SE <br />USEZON^� LOTAREA <br />NEIOHT MIT�TI� NO.OF <br />UNITS <br />�UPANCY NO.OFSiMqES OCCUP <br />FlRE' MPEO'D REASON <br />Nv <br />Fli1E SPRINKIER REOU REASON <br />0 <br />TVPE OF CONST PUNS A <br />I/ _ ,c/ . <br />SUB TOTAL S ; <br />PERMIT S � <br />TOTAL FEE S ' <br />TB�K � SI�E SEic&1CN / <br />7 J <br />V�CANT SITE <br />fiYES ❑ NO <br />� 3 s��� ���. <br />�lITdLOAD PASEMEN <br />N/7 ES ❑ NO <br />-�-s <br />CONT�CT PERSON AND PIIONE <br />L.�/tRY N�tc ts� ^ i <br />I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF U1WS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTINd OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL UW REQULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. ?HAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 298200 WAC. <br />X �_��� //— 2,_9y <br />SION�TUpE DATE <br />OR ITEM <br />A/C —AMNDL� UNITS — H, <br />FORCED AIR SYSTEMS - B <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />WATER HEATER <br />WOf1D STOVE <br />METAL FIREPLACE � <br />FIREPLACEINSERT <br />EXHAUST <br />/ I PUN CMECK <br />♦ I/ 7 <br />BUILDINO ��j �%C <br />u <br />PLLIMBING <br />MECH�NICQ <br />ADDIPONAL PLAN CHECK <br />on�en <br />STATE BUILDING SURCN�Rl3E <br />CITY OF EVEHETT PUB� IC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL <br />S <br />S <br />NO. <br />