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� � <br />APPLICATIO�1 FOR CONSTRUCT�ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8870 <br />❑ DEMOLITION ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTADDRESS: ��j �D RQ���e,Y ( fQ[�'{—, ,� 9Q�o r <br />. . . . � _ �� <br />TENMIT MMIADUPE55 f.IIY JIP ���ONE <br />ARCMTECT OR DESIGNER M�II AUOtiE55 CIIY )II� PIIONE • <br />T,1�2 i2ehn�loqu IZc,cr; rw �.�,c /!3/S 14�Cc�� ��. E, ?a�a'rY.t� /s. �p �S�S <br />GENEMICONTR�CTOR ND011E55 V CnY )il� ppdq@—� SUTELICFNSE� <br />MECN/JIICAI CONTR�CTOR MAII �DDRE55 Cltt III` PIIONE ATATE LICENSE � <br />MUMBINCCONTRACfOR M�ILADDRE55 �IIY ZIP PIIONE STATELICENSE� <br />��MSE YYORK Sq1ARE FOOT GE INVOIVE <br />4 � s4�ee.-�;�nq �-o be � <br />o��r ��c�s ' q :�oa A d� <br />CO ��iD✓� t�Co�'n 5 Sje,ry� <br />PPOPO ED USE OF BVILDINO <br />Sf � du-2.'( lrit{ <br />�ou oesc rtiori oc mov¢qn isHowr� e¢to�n�cH twc <br />LOT BLOCN OF <br />VARGEL TIVI I.D. M/MBER <br />CONSTilUOTIpN IOIW LENOER. AOME55. TElEA10NE NUMBEq <br />TYPE OF flXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKINO FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — OAR, ETC.I <br />SUB TOTAL <br />I TOTAL <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN RE�NSF.iBA�N <br />L15EIONE IOTAREA <br />MEI6HTUMITATION NO OF OWELLING <br />UNIf$ <br />0� 51(NtlFS <br />TYPE OF <br />NEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />coNnr.i ru�.snn nNn r�rone eo <br />�� �� HEAEDY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICAT�ON AND KNOW THE SAME TO BE TRUE AND CORREC T ALL <br />PROVISIONS OF LAWS AND OR�INANCES GOVERNING THIS TYI E OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREfV OR <br />coriEsl NOT. TfiE ORANTINO OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTI�IORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER StATE OR LOCAC LAW REOULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH TNE STATE <br />CONTRACTOR5 L 182 RCW 296.200 WAC. <br />x �� 2( Z c? 7 <br />SIGN�IUIIF. D�TE <br />CIIY OIISINF.SS IICENSE NO <br />FEE <br />' S <br />FEE S <br />SIDE SETB�Ck <br />V�CANT SIiE <br />❑YES O NO <br />SIZE OF BIOGR.I <br />NO. TYPE OF EpU1PMENT FEE <br />.va. — wnnuLu U� <br />FOItCED AIR SYST <br />11EAT PUMP <br />UNIT HEATERS <br />CLOTHES DRVERS <br />RANGEHOOD <br />WATER HEATER <br />WOO� STOVE <br />MFiAL FIREPLACE ( <br />FIREPLACE INSERT <br />PI AN GI ICCk N1140f R <br />OIIqpINb <br />1'1111A01Nf. <br />MfC11�NIf.A1 <br />� ❑YFS ❑ ND —' — <br />RFASON ADOIIIUNAI PI�NCIIff.N <br />ou�rn-' <br />ne�srx+ _—. <br />srar nunumr sunr.�uim¢ <br />vtnxcerrnov¢oor CITYOFEVERETT runnr.wnnxs <br />IOCAL SALES ---- -- - --- <br />oeie TAX CODE IS 3105 TOTAL <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />FEF �Ef.E1PTN0 <br />