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A�PPLICATIO�I FOR CONSTRUCT�ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •(425) 257-8810 <br />O DEMOLITION ❑ COMBINATION /� BUILDING J� MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTADDRESS: U3� � � Lo-I..IP LI.,,. <br />1ENANT MMI Q)pRE55 GTY 71V PHONE <br />ARCHITCCIORI�SIGNER IAAl1AD�RE55 GIfY ZIP 1'Hp4F — <br />UMBINGCON7R�f,TpR M�ILADOHE55 Cltt ZIP PHONE STAiELILENSE• <br />� _ � <br />OESC�E WORK A, D SO �RE FOOT�G INVCLVED <br />n <br />�� r <br />�; � � <br />PnOnO5E0 USE OF BUIIDINb r <br />LEGAL DESCRIPTIpN pF pRpi'ERTy �$�p� �py� QqATf�Ch <br />LOT BLOCK OF <br />PAR�E�TNtL�.NUMBER � <br />CONSTRtICTip/ tOAN LEN�ER, AObPE55. TEIEPHONE NUMBEP <br />PLUMBIN6 <br />• NO. TVPE OF FlXTURE OR REM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK d DISP <br />DISHWASNER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />FOR OFFICE USE ONLY: <br />FRG SFTPRLN RF.�qS <br />USE ZONF <br />ME�GNI I IMIt�110N <br />OCCIIPANCY NO 04 <br />GROUP <br />I OI �RE� <br />HEATING SYSTEM: I�GAS C ELECTRIC ❑ <br />CONT�Ci PFRSON ANO �HONr� NO <br />' � /Y):�. /.��IC�nr/.,..� �i�_7_�'//C/ <br />I HEREBY CERTIFV 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 ORDINANCES GOVERNING THIS TYPE OF <br />WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />iWOCOPIE51 p�pT. 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 COMPLV WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />x � ,�; �.���� 9/a��97 <br />SIGH�TURE p��� <br />CITY 6USINE55 UCENSC NO <br />MECHANICAI — <br />FEE NO. TYF�E OF EQUIPMENT FEE <br />' A/C —A/HNDI.0 UNITS � <br />; FORCED AIR SYSTEMS � <br />� HEAT PUMP � <br />SUB TOTAL E ; <br />PERMIT S � <br />--• <br />TOTAL FEE S _� <br />SIOE SEfB�CK <br />NO OF OWELLING <br />IINi15 <br />RF�SON <br />CLOTHES DRVERS <br />RANGEHOOD <br />� <br />SUD TOTAL 3 <br />PERMIT S <br />TOTAL FEE S <br />PtANC11EGNNUM9fR �_ �/EF �fIFf.F��!NO <br />v�cenr sire FEES <br />OYES ❑ NO pp����N6 <br />SIIE OF BLOGRI <br />PIUMAING <br />B�SEMENi MFGInNICa1 <br />❑YES ❑ NO - <br />�DUiIIONnI. PI �N C��CC� <br />on�en <br />Stnll' AIOIUING SUn�HnnGE <br />iYPF.Of f,ONSf PL�NSRPPPOVEDOY � <br />CITV OF EVERETT runur. wa�Ks � <br />LOCALSALES – ------- --�-- <br />onie TAX CODE IS 3105 TOTnL , <br />