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�. �-. <br />APPLICATII.N FOR CONSTRUCI �ON PERM�T <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION fl COMBINATION ❑ BUILDING ❑ MECHANICAL (`� j(� PLUMBING ❑ SIGN <br />P1iOJECTADDRESS Z.L,L wl�,inl�. f��11 �(�, <br />uwNER MRILIIDDRESS CITV <br />S�R���l� A`�P�at.-r ZZZ M�2.,�l� <br />TENANT ` MAILADDRESS CITV <br />SnN. e, ; Po r3 � i l y <br />DESIGNER <br />CITY <br />✓t�v r�xz , 4.1<-2s.-r qb1-crj <br />21P PIIONE <br />�� �o�l� -���° � ioz� <br />GENER/�LCONTAACTOR MAIUDDRF55 CITV ZIP PHONE STAiELICENSE� <br />3�(�-1 co�s�. aa,c c-�yi=�s s��i�,,ri� 9�iiy aa3-o�-aA�4Hics��oz <br />MEC AN NICALCpNTRACTOR MAILADDRE55 CITY ZIP PHONE STATELICENSE/ <br />'�q[TT:f3 U <br />PLUMBINP CONTRACTOR MAIL A�DRESS CITY ZIP PHONE STATE LICENSE � <br />rlazoo.�� Mec.N, g� ey$ �+a•.l�s 4�oz8 '►16-6�0o Jqrt�oJ,c �saea— <br />q},�,upo, OD <br />DESCRIBE K AND SOUARE FOOTAGE INVOLVEO <br />1 S�'r�l..�-lniC2 FC.O�YL <br />�SP�-1�1.' f �"�4+JJ�MLTUR-t— <br />LEGAL DESCRIPTION OF PqOPERTY (SMOWN BELOW OR ATT�CM TWO COPIES) <br />LOT BLOCK OF <br />F�� s�r� �9-9a- <br />PMCEL TN( I.D. NUMBER <br />CANSTRUCiION IO�N I.ENDER. ADDRE55. TELEPHONE NUMBEH <br />PLUMBINO <br />NO. TYPE OF <br />� WATER CLOSET <br />BATHTUB <br />SHOWER <br />KITCHEN SINK & DISP <br />IAUNORY TRAY <br />CLOTHES WASHER <br />DRINKIN6 FOUNTAIN <br />FLOOR DRAIN <br />SINK (SERVICE — BAR, <br />OR ITEM <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONT StTB�CK REAR SETOACK SIUE SETB�CN <br />USE <br />LOTAREA <br />HEIGHTLIMITATION I NO OF DWELIJNG <br />UNITS <br />OCLUPANCY NO.OFS70FIE5 OCCUFANTLOAD <br />FIRE <br />ov <br />FEE <br />VRCANT SITE <br />❑VES ❑ NO <br />'iIZE OF BLOG/CI. <br />❑YES f] NO <br />CITY OF EVERETT <br />LOCALSALES <br />Tax co�e is 3�os <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACT PERSON AND PHONE NO. <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 WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIDI OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVIS�ON OF ANY <br />OTHER STAT[ OR LOCAL LAW REGULATI�!G CONSTRUCTION OR TNE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEflTY TO PERFORM THE WORK FOR WHICH <br />APPLIC I N IS MADE AND I COMPLY WITH THE STATE <br />CONT A QRS LAW 1Q27 R�W AND�296200 WAC. <br />CITV BUSINE55 <br />NO. TYPE OF FlXTURE OR ITEM <br />A/C —A/HNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M <br />HEAT PUMP <br />UNITHEATERS—B.T.U. M <br />CLOTHES DRYERS <br />RANGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE � <br />FII'1EPLACE INSERT <br />GAS FIFEPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUST FAN <br />f'Ll�N <br />PUILC'VG <br />PLIIMBING <br />MECHANICAL <br />AODITIONAL PLAN LHECK <br />OTHER <br />STATE BUILDING SURCHRAGE <br />PUBI.IC 100RK5 <br />TOTAL <br />Z�'9 <br />FEE <br />SUB TOTAL $ "'U ; <br />PERMIT $ � <br />TOTALFEE $ ' <br />FEE RECEIPT NO. <br />VALUATION FEE <br />i <br />il i0D <br />