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+� �-. <br />APPLICATIO.� FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS 22Z [�v � i ��� �i �� e <br />ONMEg., � MAILADDRESS QTY ZIP PNONE <br />r �---/r ii_ _ /_ _ 11 /. _ �ln � _ s�G / .._._...__../ DRn�i_ ���_/�fili <br />1ENANT <br />DE� WOAK AND 50 <br />con✓Pyors <br />� <br />PqOPO L� USE OF BUILDINO <br />LE611lDESCRIPTON PROPE <br />LOT BIOCK <br />r, <br />ATf�CH <br />PARCELTA%I.U.NUM9EH <br />I:ONSTRUCTION LO�N LENDER. ADDRESS, TELEPHONE NUMBEN <br />NO. TYPE OF <br />WATER CLOSET <br />BATHTUB <br />UVATORY (WAS <br />DISHWASHER <br />LAUNDRY TRAY <br />URINAL <br />DRINKING F <br />FLOOR DRP <br />BACKFLOW <br />ITEM <br />SUB TO' <br />PERMIT <br />FOR OFFICE USE ONLY: <br />fRONT SETBRCK AEAR SETBACK <br />USE ZONE LOT AREA <br />HEIOHTLIMITATION NO.OFDWELLING <br />UNITS <br />OCCUPANCV NO.OFSTOPoES OCCUPANTL�OjAD <br />GRO% n /1/ /� � �'1 <br />�� <br />IRE SPR�NKIER RE� <br />N� <br />YPE OF CONST. <br />l� rR FR n�r, <br />`+� <br />3 <br />CITV <br />xc <br />��r <br />FEE <br />SIDE SETBnCK <br />uceNse. <br />PNONE STATELICENSEII <br />(eA72F�¢Z¢� <br />PHONE STATELICENSEI <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />LONTA�T� RSON (�Nq'�E yL � 7T� � ZC/ Z( / <br />/ Li / J <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OR�INANCES 60VERNIN6 THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REdUU1TINa 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 THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />x Q%�.,��� /�/l�/�� <br />�I�RE DA <br />CIi1' BVSINES$ LICENSE N0. <br />MEChANICAL _ <br />NU. TYPE OF FlXTURE OR ITEM FEE <br />`_ —r <br />AIC — AIHNDL(i UNITS — H.P. ! <br />FORCED AIR SYSTEMS — B.T.U. M E.A. 4 <br />HEf.T PUMP ' <br />UNIT HEATERS — B.T.U. M _ � <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE ( <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS FANGE <br />V�CANT SITE rcw <br />!7 VES O NO BUILDING �� � <br />SIZE OF BIDGrt.I. <br />N�� PlVM81NG <br />BASEMENT / MECNRNICAL <br />❑ VES C1 N� <br />— — AODITIOYALPLANCHECN <br />OTNER <br />STATE BIlIL01NG SURCHARGE <br />CITY OF EVERE7T rueucwonn; <br />LO�ALSALES <br />J TAX CODE IS 3105 TOTAL <br />J <br />SUB TOTAL 'i <br />PEPMIT G <br />70TAL FEE $ <br />FEF, REGtlYI rvU. <br />�1����� /��3a�� <br />