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� ��°APPLICATII.�I FOR CONSTRUC'i ;�N PERMIT <br />�v,���3��� CITY OF EVERETT • BUILDING DIVISION <br />n 3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />10LICTION C7 COMBINATION Cl BUILDING jX� MECHANICAL f� pLUMBING fl SIGN <br />PROJECT ADDRESS <br />�: S <br />A1nILA00RE55 <br />/�17�! uE <br />CITY <br />a <br />� �� <br />21P PMONE <br />��'� 9Sz�3 <br />21P PHONL a <br />ARCHITECT OF UESIGNER MNL AppRE55 CITY ZIP PMONE <br />� �wir'-rt,PD.vEt� .�Gs''iTEt15 /G! �%�s9�r"Sr, C,�l � zcrc �'�Trr F /�i0% ZZ� — /,�(, � <br />GENEMICONT(IACTOfl M�IIADDRE55 CIIY 11P PIIUNE S7ATELICENSE� <br />MELN�NICALCONTRACTOR MAI�ADDRE55 CI7V ZIP PIIONE STATELICENSE� <br />�� <br />PWMBINGCONTRnCiOR MAILAODRESS f.IfV ZIP PHONE STATEUCENSE� <br />C NT 11CT PRICE OF WORN <br />7,000 <br />DESCRIBEWORKAN�S � EFOO� <br />�;��:.� y l <br />�of �r�P ��tirr: <br />�/ Z5 C�c� �i� <br />PROP ED U E OF BUILDING <br />/L <br />LEGALOESCRIPTION OF PROPEflTY <br />LO7 BLOCK _ <br />LONSTRUCTION LOAt! LENDER, AUOPE55. TELEPNOYE NUMdER <br />NO. TYPE OF FUCTURE OR ITEM <br />WATER CLOSET (TOII.ET) <br />BATHTUB <br />LAVATORY (WASH BASIM <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SINK (SERVICE — BAR, <br />FOR OFFICE USE ONLY: <br />FRONTSETOACN RE�RSET�RGN <br />USE20NE — <br />I IEIGI IT LIMITATION <br />OCCUPANCY N01 <br />GROIIP <br />FIPE AL�RM REOII <br />FIRE SPPiN!RcR F <br />TVPE OF f,GNtiT <br />IOi�REA <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE S <br />SiDE SETB�CR <br />N0. OF DWELLING <br />UNIiS <br />PLANS APPFUVEO OY <br />FEE <br />HEATING SYSTEM: �GAS fl ELECTRIC fl. <br />CONTACTPERSONANOPNONENO. � <br />LlFn, 25Z —� / / <br />I HEREBY CERTIFY THAT I 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 TYPE OF <br />WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRFSUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PRUVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING 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 TFIE STATE <br />CONTRACTORS LAW 78.27 f�W AND 296.200 WAC. ^' <br />/ 7 � L�Z 7/�i� <br />SIG TURE T DATE <br />CITY OUSINE55 LICENSE NO. <br />MECHANICAL <br />NO. TYPE OP EQUIPMENT FEE <br />A/C — A/HNDLG UNITS — H.P. <br />FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />HEAT PUMP <br />UN�T HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />; RANGEHOOD <br />WATER HEATER <br />' WOOD STOVE <br />; METAL FIREPLACE I <br />� FIREPLACE INSERT <br />VACANT SIiE <br />f 1 YE5 I i NO <br />9ZE OF OIOGrtI <br />BASEMENT <br />IIYES II NO <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />GAS FIREPLACE <br />GASRANGE <br />EXHAUST <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE S <br />PL�NCIIECKNUMOER � �FEE �REGEIPTNO. <br />OUILNNC. <br />PLUMOING <br />MELHnNICQ <br />ADDIiIONAL PUN CH[LK <br />OT11ER <br />STr1iE fll11LDING SUfiC11A0GE <br />rum ir, wonKs <br />TOTAL <br />