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APPLIC�►T11..d FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />(7 DEMOUTION � I COMBINATION I I BUILDING i I MECHANICAL f 1 PLUMBING �l SIGN <br />PROJECT ADDRESS � :� � -� �� p � Ke FEc«r� �G%t^ � <br />OWrlEfl MNLAUDRG55 CIiY :IP PIIONG <br />�n.�rl�A[ ?,4rc/<<� ViS�4/}S <br />ieNnrvr Mnn.noor��ss cirv zm F�+oue <br />nnc��rtr.cr on <br />GITV ZIP PNONE <br />GENERALGONtfiAGiOR MAIL�OOftE55 CIiY ZIP PHONF: STATELICENSEr <br />/19AC-Cy ('QF%-SI�RU<%'idn,� /�31/ �n�/A✓�.n,�,W AtsU�. �la�1)/ ES�-.S6G� h�ACdYG�07i0A <br />MEClIANILAL CONTIiACTOR MAIL AD�RESS CITV i ZIP PIIONE SiATE UCENSE � <br />PWM9INGCONiRACTOP MAILAODRE55 Cltt ZIP PMONE STATEUCENSEr <br />OESCRIBC: WORK PN� SOU�RE POOTnGG INVOLVED <br />LEGAL DESCRIPTION OF Pi70PE <br />lOT OLOCK <br />rnacei <br />CONST(iUCTION LOAN LENDER, POORESS. <br />C', H. / �? r�.c.TfC? <br />NO. TYPE OF FI%TURE OR <br />WATER CLOSET (TOILET) �I <br />i BATHTUB <br />1 � LAVATQRY (WASH BASIN) �� <br />-L SHOWER �� <br />% ITCHEN SINK 8 DISP �� <br />TRAY <br />FLOOR DRF <br />BACKFLOW <br />NIIMBER <br />SUB T • TAL S ; <br />PERMIT S � <br />TOTAL FEE £ ! <br />FOR OFFICE USE ONLY: <br />FRONT�T�ACK� RC.M SFTf1� ! Slf]E <br />/17 � 4 <br />US[IONf: � � IOTAREA VACANi51TG� <br />f� J nves r, No <br />NEICIITIIMITATlO� NOOFpWELLING SIZEOI�I�G�TI <br />UNIiS G � <br />V <br />OCCUPANCY NO CiS10RIE5 OCCUPANiIO�D BASEMENT <br />FIFiE <br />FEASON <br />ri na; <br />onTe <br />f1 YE5 Il `JO <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />HEATING SYSTEM: fl GAS ❑ ELECTRIC f7 <br />CONiACT PERSON PND PHONE NO. <br />- �i%'i�� <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 COMPIIED WITH WHETHER SPECIFIED 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 AUTHORI2ED 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 L.1W 7827 RCW AND 296.200 WAC. <br />x � y � <br />SIGNATUP[ �ATE <br />CITV OUSINESS LICENSE NO. <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />A/C —A/HNOLG UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T,U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />VENTILATION FAN <br />RA�GE HOOD ji <br />WOOD STOVE <br />METAL FIREPIACE (Wn p i <br />FIREPLACE INSERT (WC 1D <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />Ol/1LDING <br />PLUMOING <br />MELM4NICAL <br />ADDITION�L PLAN CHECN <br />OTHER <br />ST�iE OUILDING SURCHARGE <br />runuc woaKs <br />TOTAL <br />SUB TOTAL 5 � <br />PERMIT S � <br />TOTAL FEF 5 ' <br />FEE I RECEIPTNO. <br />�n i • ti ) <br />i <br />Cl i - <br />