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APPLICATIOrI FOR CONSTRl.1C7.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVFRETT, WA 98201 • 259-8810 <br />��DEMOLITION �l COMBINATION f � BUILDING I 1 MECHANICAL f� PLUMBING f-1 SIGN <br />PROJECT ADDRESS � <br />Hl Ls' <br />ONRiER IdAIU <br />TENANT <br />MIILADDRE55 <br />CITV <br />CIiY <br />PNOYE <br />z.t 3- � r.ri' <br />�J <br />ARCNRCCT OR OESIGN[R MAIL RDURE55 CIiY ZIP PHONE <br />�� <br />GENENFLCONTPACTOR MAILAODRESS CI1V ZiP PHONEr=���j'Jp6TRTFLICENSE� <br />w�G/�Oi/�✓�-,t�✓G. S/a7 Z��� J:. Jc. �,.n�a,wvicc� 7aoJz za�-��-�o-dB-�vredtcc <br />MELHANICPLCO47RAC'OR MAILA�GRE$$ CITV 21P PMONE STRTELICENSE� <br />/��� <br />PLVMBING CONTRACTOR MAIL ADOPESS GIIY ZIP PHONE STATE LICENSE • <br />CONTROCTPRICEOFt ORK <br />pESCRIBE WURK RM1O SOUPRE FOOi�GE INVOLVEO <br />ti.,1(�G /L�•Do�i M►✓su <br />! Yo � ° /`� ' <br />PROPOSE� USE OF BUIIDING <br />LEG�L DESGRIPTION OF PROPERtt ISHOYM BELOW OR AnACH TWO CC <br />LOT BLOCN �O�F— <br />5a°.�� U� (� / /' c,l./ 3 �>a <br />/AJ <br />PRRGELTA%ID NUMBER � <br />�oaS- r)O 3 �j � `� <br />CONSTRUCTON LOAN IENUER. �DORE55. TELEPIIONE NUMBEN <br />PLUMBINO <br />NO. TVPE OF FIXTURE OR �TEM <br />WATER CLOSET (TOILE� <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK BERVICE — BAR, ETC.) <br />FOR OFFICE USE ONLY: <br />fPONTSEiBACN REAR SETOACK <br />USE 20N[ <br />IIEIGHT IIMIiAiION <br />OCCUPANCY IW.OFStORiES <br />IOTAREA <br />SUBTOTAL 5 <br />PERMIT S <br />TOTALFEE $ <br />SIDE SET�nCe <br />N0. OF OWRLING <br />UNiiS <br />OAIE <br />HEATING SYSTEM: (�l GAS fl ELECTRIC ❑ <br />COYIDCi PEPSON AND i'HONE NO. <br />I HEREBY CERiIFY 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 GOVER;JING THIS TYPE OF <br />WORK WILL BE COMPLIED N71TH WHETHER SP'cCIFIED HEREIN OR <br />h0'. THE GRANT!NG OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOR�TY TO VIOLATE OR CANCEL THE PR�)VISION OF ANY <br />OTHER STATE OR LQCAL LAW REGULATING CONS79UCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AU'� HORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOPM TH[ 'NORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS lAW 1827 CW AND 296200 WAC. <br />/� S-fi <br />IGNRT E DRTE <br />CITv BUSINE55 LICENSE NO. <br />NO. <br />TYPE OF F <br />A/C — A/FiNDLG UI <br />FORCED AIP SYST <br />HEAT PUMP <br />UNIT HEATERS — <br />CLOTHES DRYER: <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACI <br />FIREPLACEINSEF <br />GAS FIREPLACE <br />GASRANGE <br />uA5 PIPING <br />F%HAUStFAN <br />RE OR IT <br />— H.P. <br />— B.T.U. <br />M <br />I SUB TOiAL $ �_ <br />� PERMIT S <br />TOTALFEE $ <br />PLAN CNEGK NIIUOER _ FEE PEC[IPT N0. <br />VACRNT SITE <br />f1YE5 f1 NO pUILOI!!G <br />SIZE OF OIDGRI. <br />P W MOING <br />BASEMENi MECNRNICAL <br />❑VES fl NO <br />ADDITIONAI PIAN GH[CK <br />OiNE(i <br />STP1E �UIIDING SURCHRRGE <br />CITY OF EVERETT ruaucwonres <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />FEE <br />