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APPLICATION FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUI�DING DIVISION � <br />3200 CEDAR STREET • EVEREI"f, WA 98201 • 259-8810 <br />fl DEMOLITION (� COMBINATION I� BUILDING ❑ MECHANICAL f� PLUMBING fl SIGN <br />PROJECT ADDRESS <br />5-i/5 w�fm�rc G uc�c1� �1v/ <br />OWNER MPILFDDRESS CITY 21P PNONE <br />+�/ /r•�/�... S y/S wr4,.,ure /-"vciG�/d ri K.7oI 35-Sl�l� <br />IFY�Ni Mh�UDDRESS CITY zIP PIIONE <br />�- <br />ARCHITECTOPOESIGNER MPILADDRE55 CITY 21P PMONE <br />O w/�r� <br />GENERRLCONTPALTOq MAILPDORESS CRV 71P i'MONF: SiATELIGENSE� <br />11 <br />MECHANICALCONTRACTOR MAILADDRE55 CITY ZIP PHONE � STATELICENSE� <br />PLUMBING[ONTRRCTOR MAILADDRE55 CITV zlP PHONE StATELICENSE� <br />1! <br />OESCRIBE WORN ANO SOUARE FOOiAGE INVOLVE� <br />4oU�.,{y r.'.Q.•-,. 1 nie <br />9 2ov.�. d= ���or <br />FROPOSEO lISE OF BUILDING <br />G � e <br />LEGAL DESCRIPiION OF VROPERIV � ONT! 9ELOW OR ATfRCH <br />LOT BLOCN OF <br />U�IS-� J��ON J�U$ <br />PN CELTA%ID.NUMBER <br />CONSiRL•GTION LORN LENDER. �DDRE55. TELEPXONE NUMBER <br />PLUMBIN6 <br />NO. TYPE OF Fl%TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORV(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING fOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK 1SERVICE — BAR, El <br />YN1�c11 <br />HEATING SYSTEM: ❑ GAS f7 ELECTRIC ❑ <br />CONTACT PEPSON AND PMONE NO. <br />I HEAEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPI.ICATION AND KNOW THE SAME TO BE TRUF AND CORRECL AlL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIEU WITH WHETHER SPECIFIED HEREIN OR <br />TWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PFlESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION JF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MAD AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1B RCW AND 296200 WAC. <br />x �'��� � s�5��i 5- <br />SIGNRTURE DATE <br />S <br />FOR OFFICE USE ONLY: <br />FRONTSETARCK RE�q SET9ALN SIUE SETBACK <br />USE ZONE <br />HEIGIIT LIMITATION <br />CONST <br />IOTARER <br />NO OFUWEWNG <br />UNITS <br />PLANS APPROJEO BV <br />CITY BUSMESS LICENSF N0. <br />TYPE OF FIXTURE OR ITEM <br />A/C — A/FiNDLG UNITS — H.P. <br />FORCEO AIR SYSTEMS — B.T.U. M E.A. <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 BURNING) <br />FIREPLACE INSERT (WOOD BURNING) <br />GAS fIREPLACE <br />FAN <br />SUBTOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />PLAN CNECK NU B I F[E I RECEIPT NO. <br />�"� ���> <br />VACANT SITE <br />flYES Il NO OUIL�ING <br />SIIE OF BLUGRI. <br />PLUM�ING <br />BASEMENT M[CNANICAL <br />❑YES fl NO <br />hDDIT10YAL PL�N GHECK <br />OTNER <br />STFTE �UIIDIHG SURCH�RGE <br />CITY OF EVEREIT ' rueuc wor�Ks <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />FEE <br />a <br />