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APPLICATI/,�1 FQR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION � ❑ BUILDING �CHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: � -�-L�/ /L �I /�//T/-=7-� A,l,� 11 <br />�RLNITECTORDESIGNER M�IIQIORE55 GItY )II' PIpNf <br />PWMBINGCONTR�CTOR M�IlA00RE55 Cltt IIP PNONE SUTELICENSE� <br />� � <br />OESCRIlE WpRK AND $pUARE FOpTApE INVOLVED <br />w1 <br />PMLEL <br />oF r�areRn isNown eeiow <br />_ BIOCK pF <br />�- w c-- V f�}- ' V C <br />LENOEH, AODRESS. tELEP/pHE NUM9ER <br />NO. TYPE OF FlXTURE <br />WATEq CLOSET (TOILEn <br />BATHTUB <br />SINK 8 <br />CIOTHES WASHER <br />URINAL <br />DRINKIN6 FOUNTAIN <br />FLOOR ORAIN <br />FEE <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE f <br />FOR OFFICE USE ONLY: <br />FRON75ETBACK PEARSET811CN <br />USE20NE <br />HE16NT LI W T�TION <br />LOT�REA <br />MO OF DWELLING <br />VNI�C <br />SIDE SEiBSCK <br />V�CANT SITE <br />❑YES p= <br />SIZE Oi B106R1 <br />❑YES ❑ NO <br />HEATING SYSTEM: �AS D ELECTRIC ❑ <br />LONIACT PCRSON AND PNONE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEP 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 WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOCAL LAW REGULATIN6 CpNSTRU(:TION OR TME <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PR ERTY . PERFORM THE WORK FOR WHICH <br />APpLICATION IS ADE ND COMPLY WITH THE STATE <br />CONTRACTOR. AW 1 CW�FN 296200 WqC. <br />X C� I � i <br />SICNATURE D�TE <br />CITY BUSINESS LICENS[ NO <br />HU• � TYPE OF EOUIPMENT —� FEE <br />� FORCED AIR SYSTEMS <br />� HEAT PUMP <br />' UNIT HEATERS <br />� CLOTHES DRVERS <br />' RANGEHOOD <br />I WATER HEATER <br />WOOD STUVE <br />' MEfAL FIREPLACE (VJOC <br />FIREPIACE INSERT (WOi <br />GAS FIREPLACE <br />GASRANGE <br />PUN �IIELN NUMBffi <br />Ol111I71Nf. <br />PIUAIpINO <br />MECII�NILM <br />RDDIIIpN�L PIAN CIIf.CM <br />OIII[❑ <br />SIAIG pU1101NG SIIIIC����OE <br />rrveorr,or�st r�nNser�noveoer CITYOFEVERETT runnr.wonrcs <br />LOCALSALES <br />o�TE TAX CODE IS 3105 TOTAI <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE S � <br />(EF PECF.IPTNO <br />