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APPLICATItiN FOR CONSTRUCti �ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />32po CEDAR STREET • EVERETT, WA 98201 • 259-eeto <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: 3 %�� /%1� DD�(/�t-�- /i✓E <br />OWNER M�t �E55 GITY LP PNONE <br />? 10� 3lv S� G-v� �av /�-��3 - l�'/v J <br />TEWWT MNUDORE55 f.IIY 71P M�ONE <br />�'aa,r_� visTz..adn,.�� ��� zs9�-43s4- <br />�RCWTECTORDESIGNER M�IIPUDRE55 CITV )n` PHONF. <br />h/C 6 Roc,rwi�y 3�� w�r,.� .N� �rr _ zst - G 8 4-S <br />GENEHKCONTRACTpi MNL�[WRE55 LI�Y IiP ���ONE SI�TEUCENSE� <br />�,4`��/cv i�iS /av� /c 5� �txnc� 9,�Zod <br />YECH�NICµC HACTOR M1UlADDNE55 Cltt 2iP PnONE STATELiCENSE� <br />�R1XwT f'��t ZoeFQ 4��`�.N��-E �ico�.�n' /✓p 9�fzf- ��•9�-za9v /.rr',¢i6✓b99CF <br />PWMBINGCONTPACTOR M�IL�DONE55 LI1Y ZIP PHONE ST�TlIICENSE� <br />OESCRIBE YqRN �ND SOUAR[ FOOT�GE W VOLVED <br />LOT <br />NO. <br />D,�SF <br />use oF eu�ano <br />" � �/�/6t�/3' �+N/acF1�OZ< < <br />:wvr�ON OF PHOFEaiv (SNOwN eElow OR �n/�CN <br />BLOCK OF <br />f I.D. NUAIBER <br />IION lQW LENOER. AWPESS. TELEA�ONE NUYBEP <br />16 <br />TYPE OF fll(TURE ON ITEM <br />WATER CLCSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KRCHEN SINK 8 DISP <br />DISHWASHEF <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKROW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN REM SETBAC1c <br />USE20NE <br />NEIGMT LIMITATION <br />FIRE <br />OF <br />lOT AREA <br />NO OG OWELLING <br />UNII[ <br />OCCUPANTLO�D <br />O�TE <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />f.ONUCT PCIISON AND PIqNE NO <br />I HEREBY CERTIFY THAT I HAVE READ ANO E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALl <br />PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIEO 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 AUTHORIZED BY THE <br />OWNER QF THIS PROP ERTY TO PERFORM THE WORK FOR WHICH <br />APPLICAI�IqN IS M�1DE AND I COMPLY WITH THE STATE <br />CONTRAdiORS LAW :827 PGW AND 296.200 WAC. <br />x��L ����'----- l°jGXl7! <br />SNiNATUR V D� �/ �� D�TE <br />r (o <br />CITY EUSINE55 LICENSE NO. <br />MECHANICAL <br />FEE N0. TYPE OF EOUIPMENT FEE <br />� NC—NHNDLGUNITS <br />; FORCEDAIRSYSTEMS <br />� HEAT PUMP <br />� UNIT HEATERS <br />; CLOTHES ORYERS <br />� RANGEHOOD <br />� WATER HEATER <br />; WOOD STOVE <br />� MEfAL FIREPLACE (WOOD BURNING) <br />� FIFiEPLACE INSERT (WOOD BURN�NG) <br />� GAS FIREPIACE <br />! GAS RANGE <br />TOTAL S <br />UIT S <br />\L FEE S <br />Si�E SETB�CK <br />V�C�NI SITE <br />❑YES O NO <br />SIiE OF BLDG/TI <br />BASEMENT <br />❑YES ❑ NO <br />P�AN CIIECN NUMBER <br />BUR�INf. <br />PlU1d01NG <br />MECN�NIC�I <br />�DDIIIONAL PUN C��f:Ck , <br />OLHER \ �lJ;r <br />STAIE <br />DVEDOY CITY OF EVERETT �IIBUf. WORKS <br />� LOCAL SALES <br />��/�� /��, TAX C.ODE IS 3105 TOTAL <br />511IICN�II6E <br />S <br />f <br />iEF_ /jI a� I RECEIPT r+0 <br />i� <br />