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APPLICATION FOR CONSTRUCTIJN PERMIT <br />CITY OF EVERETT' • BUILDING DIVISION <br />��- : �.J�� 7:- 3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION fl COMBINATION rl BUILDING f-I MECHANICAL fl PLUMBING fl SIGN <br />PROJECT ADDRESS <br />/�4/9 .':�='//�/li<� ;=�iL�� � /1���?; ,.;,, �-.�z0/ <br />VWfltl� MNILMVll11LJi �.111 \ L11' 1'I�VfJt <br />L i�.���� C�� [./P.-,','/1 �^^`-��'�J(_l <br />.�-» ////� _ <br />ARCIIITECTORDESIGNER MAILFDDRE55 CIIY ZIP PMONF. <br />. <<� �:1tql�J- <br />GENERRLCONTRACT08' MRILADDRESS CITV I.IP PIIONE cTATEUCENSE� <br />�/�lif/1FYl/�Y �z,/,S": (u. _:ri('. }�U BUx %�'S G+✓CJU//(/L�l(E� �:,� 9�'o7Z E*✓TF�iC2Y7CrJ <br />fAEC4ANICALCONTRACTOR MRILADDRL55 CITV ZIP PHONE STATELICENSE� <br />— /`l�j� — <br />PLUMBING CONTRACTOR MAII,ADDPE55 CIIY 21P PHONE STATE LICENSE � <br />_ n�/r� _ <br />CONTRRCTPRICEOFWORK - '� <br />r/iIF/-i',%%e�/�ri»��l t/5/��2Q�"—`� HEATINGSYSTEM: [7�GAS r]ELECTRIC ❑ <br />DESCRIBE VIORN AN� SOUARE FOOTAGE INVOLVED CONT�CT PERSON AN� PMONE N0. <br />-���F/,Y✓ti1l�F -�Eni��rl To A��/C i1[�'lEv� <br />QFG�VF4 P/1�--r��.S� �all - /�iE�? ! J/�'.: <br />�(iSi�p�G SiNl� (t� Fi���i/(Y /�c�rlvn.L <br />LEO�L DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATfACH TWO GOPIES� <br />LOT _ BLOCK OF <br />PARCEITA%I.D.NUMBER <br />�/3yv-3G�-D�� -ocx�l <br />CONSTAUCTION LOAN LENDER. PDDRESS. TELEPMONE NUMBER <br />PLUMBINa <br />NO. TYPE OF FIXTURE OR ITEM <br />BATHTUB <br />LAVATORY <br />KITCHEN SINK & DISP <br />DISHWASHER <br />CLOTHES WASHER <br />URINAI <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />CINK lCFRVICF — RAFi F7 <br />FOR OFFICE USE ONLY: <br />FFONTSETBACK REnP SET�nCN <br />USEZONE <br />HEIGIIT LIMITAiION <br />OCCUPANCV NO( <br />GROUP <br />FIRE AURM REO'D <br />SUB TOTAL 3 <br />PERMIT $ <br />TOTALFEE $ <br />SIOE SETBACN <br />LOTAREA <br />NO OF DWELIING <br />UNITS <br />OCCUPANTLOAO <br />REASON <br />REASON <br />PLANS APpROVEO OV <br />/��I'//d �/ ;' � ir! CE �L <br />�rviLil,� ;;;;'t- (t/n,�i. %Pi� 37?U <br />`�" I HEREBY CERT�FY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT �OES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTflUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />x _� y_' //�7�9 �/ <br />SIGNAIURE DATE <br />VACANT SITE <br />IlYES fl NO <br />512E OF BLDC?I. <br />❑VES Il NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />pTY BUSINE55 LICENSE NO. <br />MECHANICAL <br />NO. TYPE OF FI%TURE OR ITEM FEE <br />A/C — A/HNDLG UN�TS — H.P. <br />FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />WATER HEATER <br />WOOD STOVE <br />FIFEPLACEINSE <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL $ <br />PERMIT $ <br />PLAN CNECN NUMOER _ I fEE I FECEIPi NO. <br />O11110ING I I //i /!— <br />P W M�ING � <br />i <br />MEC114NICAL i <br />� <br />ADDIiIONAL PIAN CHECN i <br />� <br />Oi11ER � <br />� <br />� <br />STATE OUILDING SURCH�FlGE i� <br />PUBLIC WORKS � <br />I <br />TOTAL "/ � � i'/ <br />