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m <br />APPLICATIOr�I FOR CONSTRUCT�ON <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, W 98201 • 259-8810 <br />fl DlWI(�LITION �l COMBINATION I-1 BUILDING fYl MECHANICAL <br />ADDRESS <br />PERMIT� <br />rl PLUMBING fl SIGN <br />OWNER M�ILA�DRESS � - CItt �` ZIP PHONE ���o� ��Z-�8 6�7 <br />�To� �� �. � 3"� �( � iG7 F�1 �_RI� 2 WA- .� tz� <br />�NT MMUDDtIF.55 �ITV 2iP p��pNE <br />�:� w�ibo„/ o2S�7 ua,l�,�-F Sr ��e,�x� C��) ZS`?—bSY,C <br />ARGNITECTORDESIGNER M�II��ORE55 CIIY ]IP PHONF. <br />GENEMICONTpALiqi MML�DDRF55 QIY irP P�ION[ $GiEUCENSE� <br />MECH�NI�ALCONTRACTOR MqIADDRE55 Qtt 21P PHONE STRTEUCENSE� <br />��r3_ �T^1 �- �.o�enLr'' !'/o y 1�'.��o w1 �LZ°T �n/ 5�/�� 3 <br />PLJMBINGCONTR�CTOR MRILAOURE55 CILY ZIP PIIJNE S tELICENSE� <br />DESCRIBE NVRK AND SOUnRE <br />F�..ov ia(��.• a <br />/iJ t ' i�/ <br />GJr'�� 'fDu�f <br />PROPOSF.D USE OF BUIIdNG <br />2G�-rn-L <br />LE(3AL DESGRIPTION OF PHOPf <br />l0T BLOCK <br />INVOLVEO <br />� <br />PARLEI LV! I.D. NUMBER <br />y��� -003 -oro-�i000 <br />GONSTRUCTION tOM! LENOEP. �OdiE55. TELEPMtN1E NUM9ER <br />KITCHEN <br />LAUNDRYTRAV <br />CLOTHES WASHEH <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFIOW PREVENTERS <br />SINK (SERVICE — BAR, E7 <br />FOR OFFICE USE ONLY: <br />FRONTSETPRCN RE�fiSETP�CN <br />USE 20NE <br />HEIGNT IIMITQION <br />OCCUPANCY NO 0[ SIONiES <br />GROUF <br />FIRE QARM BEOD <br />FlRE SPRINKI ER RFOD <br />1 Ot �REA <br />NO OF OWF.LUNG <br />I1NII5 <br />PI �NS MPROVEO AY <br />FEE <br />)TAL $ <br />f $ <br />FEE E <br />SIDE SETBRCM <br />V�C�NI SIfE <br />IIYES fl NO <br />SIZE OF BLOGRI <br />BRSEMENT <br />IIVE$ II NO <br />HEATING SYSTEM: I�f'fiAS fl ELECTRIC f� <br />CONT�CT PERSON I1ND PNONE NO <br />I HEREBY CERTIFV THAT I HAVE READ AND E%AMINED THIS <br />XPPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />�PROVtSIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br />NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />X� �2 9- � �� <br />SIG�UTUpE O�TE <br />b;�tl_�ZSr <br />CITY BUSINESS LICENSE NO. <br />TYPE OF EOUIPMEHT <br />A/C — AMNDLO UNfTS — H.P. <br />FORCEDAIRSYSTEMS—B.T.U. M <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METALFIREPLACE(WOOD BUFNING <br />GAS <br />PUN CIIECN NUMBF.R <br />BUIIOWG <br />PLIIMHING <br />MEG�ANiCM. <br />ApD�110NAL PtAN CNF.CN <br />0111ER <br />STRI[ AUIIOMC SVRf,IURGE <br />CITYOFEVERETT ruxiir,wonKs <br />LOCAL SALES — <br />TAX CODE IS 3105 TO7AL <br />SUB TOTAL S <br />PERMIT : <br />TOTAL FEE S i <br />FEE REf.EIf'T NO <br />