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APPLICATII�i�I FOR CONSTRUCi �ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />f� DEMOLITION fl COMBINATION fl BUILDING fl MECHANICAL f � PLUMBING f 1 SIGN <br />PROJECT ADDRESS ��� �7 � � ��� , � � ;"%i ., , I�J.� <br />i <br />OWNF� � M�R�DDRE55 Itt 2iP PNON <br />/1 /... . �i_-�.. ��_ /J,._.� .n.� �/ Cii) %� _ �i 4 n �i.. -o-i. _ 9qn%� <br />11NCMITECT OR OESIGNER MRII AODRE55 ��T�' <br />MRIL�D�RESS GIIY ZIP PIIONE STATEI�G[NSE� <br />MECH�NILALCONTRACiOR MRILADDAE55 CITY Z�F PIIONE S�A�EUGENSE� <br />PLUMBINGCONIRACTOR MAILAWRE55 CIiY 21P PNONE STATELICENSE� <br />CONTRACT PRICE OF WO(iK <br />OESCRIBE WORK AND SOIIPRE FOOTAGE INVOlVEO <br />- itynia,� <br />LOT U � BIOCN <br />PARCELTA%ID.NUMBER <br />CONSTRUCTION LOAN LENDER, ADMiE55. TELEPHONE NUMBER <br />NO. ' TYPE OF FlXTURE OR <br />' WATER CLOSET (TOILET) / <br />/�, BATHTUB <br />KITCHEN SINK 8 DISP <br />CLOTHES <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE - BAR, El <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SFTMCK AE�R SETBALN SIDE SE' <br />_�D ZO Z <br />USE 20 LOTAREA VRCRNI <br />��' <br />FEE <br />HEATING SYSTEM: f� GAS f�l ELECTRIC fl <br />CONTACT PERSON RND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO 9E TRUE AND CORFiECT ALL <br />PROVISIONS OF LAWS AN� OR�INANCES 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 GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY '--� <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WURK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />x <br />SIGNATURE DRTE <br />CITY BUSINESS IICENSE NO. <br />PLAN <br />q/li — W 111VULU UIVI I J-1'1. <br />FORCED AIR SYSTEMS - B <br />HEAT PUMP <br />UNIT HEATERS - B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPIACE (WOOD <br />FIREPLACE INSERT (WO00 <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUST FAN // // <br />��/ �(ES fl NO OI11101NG <br />L <br />NEIGNTL�MITTION NO.OFUWELLING SIZEOPBLWrt/J <br />Z UNITS / � �o� 6 S! PLUMBING <br />� a,,<, �L <br />OCCUP�NCY NO Of SIO�iES OCCUPANT LOA� 9ASEMENf' AIECIIANICAL <br />6R0 /-� <br />/. J G,� fIYES NO <br />J P�O�IIONAL PI�N GNECN <br />FIRE AU�M �EO'� RFA50Y <br />Np on�En <br />FIRFSPRM IERREO'D �EASON <br />� STP1F OUILDING SVfiCNnRCE <br />TYPEOFf,ONST PI�NSAPPROVEDBV CITYOFEVERETT ruour,wonKs <br />i LOCAL SALES <br />�� op�ET� 9 I'�/;.` TAX CODE IS 3105 TOTAL <br />FEF <br />M E.A. <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />nEr,emr No. <br />U J t� <br />_lJ–f---�-- <br />� �J� <br />/:/:i� j :! <br />