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� <br />APPLICATIOIr FOR CONSTRU�TIVN PERMIT <br />CITY OF EVEREff • BUILDING DIVIS�ON <br />3200 CEDAR STREET • EVERETT, WA 98201 •(425) 257-8810 <br />❑ OEMOLITION ❑ COMBINATION ❑ BUILDIN(i A❑J. ,�MECM�AN,IC�A�L�Q�. ❑ PLUMBIN(i ❑ SI�iN <br />PROJECT ADDRESS� � S�% N�� ��� �T�C. � L�v"'.c.� R��O <br />� 7�tiN�- k�,�be�� ���1te ��o� kF'►�k� �4ve. � f,w4 ��ol �ya5�35a-o6�� <br />TENIINT Mq�A00FE55 CITY =Ip PHONE <br />�RCMIECTOROESIGNER MMIADORE55 Cltt Im PHONE <br />GENER/�L GONTMLTOR M�I� /�pDf1E55 CiTY piP PHONE SGtE uCENSE � <br />GECNINICALCONTRACTOR MMLADORE55 Cltt zIP FNONE ST�TF.LICENSE• <br />PWMDMGCONTRAf,TOii MMlAWf1E55 CITY pP 7NONE ST�TEIICENSE� <br />�pNIMCT PiMCE OF MI011K <br />DESCRIBE WORK �NO SOU�RE FOOTIWE �NypLVED <br />Q�,1 ` �'"ian 'FY2e S�w'� <br />'&u-nc 35ioo� BTU ' ��r <br />P110POSED USE OF EUIlDINO <br />LEOAL OESCRIPTION OF PROPERTY (�bM'NlELOW OR �TT/iCH 1W0 <br />lOT BIOCK OF <br />IMIILE� TIUI I.D. MAMER <br />CpHSTRUGTlp1 IOAN lENOER, �DD�E55, 7ELEP110NE NUMSER <br />nursn�o <br />N0. TYPE OF FliITURE OR ITEM <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCMEN SINK 8 DISP � <br />DISHWASNER <br />LAUNDRYTRAV <br />CLOTNES WASHER <br />URINAL <br />DRINKIN6 FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE - BAR, ETC.) <br />SUBTOTAL S <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FPONT SFTPACK AF.�R SEiMCK SIUE <br />VSE ZONF <br />11NE� <br />NEIGNT IIMITIITION I NO. OF DWELLING <br />11N11S <br />OCCUPANGY NO 0� SInNaS O(:CUP�NI LOAD <br />RF�SOV <br />V�C11NT SITE <br />�YES O NO <br />OF BLOGRI <br />❑Yf5 O Nn <br />CRY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />HEATIN(i SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACT PER50N AND PNONE NO <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF l.AWS AND OHDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO (31VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW FEOULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WMICM <br />APPLICATION IS MADE AND I COMPLY WITH TNE STATE <br />CONTRACTORS LAW 1827 RCW AND 298.200 WAC. <br />x <br />9GN�TlIRE D�TE <br />GiY EU5NE55 tICENSC NO <br />L'L�� <br />MV � NITI <br />FORCED MR <br />HEAT PUMP <br />CLOTHES DRVERS <br />CN� <br />PUN CIIECK NUMfIER <br />BWlD�N6 <br />PIUMflING <br />MFf.N�NlC.111 <br />�DD�IIONM. PIAN CN(CK <br />O1NER <br />ST�IE PIIIIOINO SIIfiC11�fIGE <br />ri ini ir. vronKs <br />TOTAL <br />SUB TOTAI S <br />PERMIT S <br />TOTALFEE S <br />fEF AECEIP7 NO <br />FEE <br />