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APPLICATION FOR CONSTRUCTION PERMIT� <br />CITY OF EVEREIT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 •�'"' <br />❑ DEMOUTION �l COMBINATION f� BUILDING I� MECHANICAL (-I PLUMBING Cl SIGN <br />PROJECT ADDRESS <br />OWNER MRILADI <br />/1 NN/� �"�S r 5 I tY <br />TENANT MTILR01 <br />.S/� <br />LqWN <br />GUOflr�-t<ic�,�—h <br />Cltt ilr <br />F�IrRF-�; l--A <br />CITV 21P <br />152 �.StYo <br />P110NE <br />PRCHITECT OR UESIGNER M0.IUDORc55 CITY ZIP PNONE <br />C `((B <br />GENEPALGONTRPCTOR MAILAODi1E55 CITY ZIP PIIONE STATEUCENSE� <br />/✓A�/S✓i'ir �Nr, 2i 3 L H�GH�A,-n ^�E F�/C/�E17 9�La 1 i5i7Y5o �,.iACR,ac.� z3ooH <br />MECHAN:CALCONTRACTOH MAIIADDRE55 Cltt ZIP PHONE SUTELICEKSE� <br />PLVMBINGCONTRACTOR MA�LAOURE55 Gltt 21P PNONE STRTEUCENSE� <br />�7(Y� — <br />�ESCRIBE WORK r1ND SOII�RE FOOiAGE INVO�VED <br />s� R�P F�F' �'p k6R��r- —n�r�r �S. <br />Ek`if1�4 C¢II� �vC�: l3vica po�4r <br />�/ pu <br />0 U �% ,L4 INJT9ytGy7TMJ <br />PROPOSED USE OF BUILDING <br />�r-srn,Fi��' <br />LEG�L DESCRIPTION OF PROPERtt �SMOMM BEIOW OR ATTRCH TWO COPIE <br />LOT � BLOCK OF P���r O�� G <br />-�E�Rn� AOOI�u� T� e=y�rn- <br />lio«M[ (�,Pnt.: vi <br />CONST1iUCilON LO�N LEN�ER. �ODRESS, TELECNONE NUMPEfl <br />NO. <br />SHOWER <br />KITCHEN <br />LAUNDRYTRAY <br />CLOTHES WASF <br />URINAL <br />DRINKING FOUD <br />FLOOR DRAIN <br />S W K (SERVICE — <br />FEE <br />PERMIT S � <br />TOTALFEE $ ' <br />FOR OFFICE USE ONLY: <br />FRONTSETBALK REARSETBRCK SIOESETBALK <br />USE20NE LOT�REA V�CANi51TE <br />IlYES Il NO <br />NEIGMTLIMITPTION NO.Of�WELl1NG SIZEOF9LIX'iRl. <br />UNIiS <br />OLCUPANCV <br />GROUP <br />FlRE AURM <br />onre <br />❑YES fl NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACT PERSON RND PIIONE NO. <br />1�n0� .inin..i. � St_7�SD <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPL�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PER'dIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CNNCEI THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 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 1827 RCW AND 296.200 WAC. <br />X i��,_ ,. _ �J i���C <br />SIGN URE � OATE / ^ C'_ �� <br />6 <br />CITY BUSINESS LICENSE NO. 'i Q 2 I <br />OF FI%TURE OR ITEM I FEE <br />A/C —AMNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE <br />FIREPLACEINSERI <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPIhG <br />EXHAUSTFAN <br />TOTAL 3 <br />NI7 S <br />1L FEE $ <br />PUN CHECN NUMOFR I FEE I RECEIPT N0. <br />BUILOING <br />PWMPING <br />MECHRNICAL <br />qD01ilONPL PIAN CHECN <br />OTN[R <br />STRTE BUILDING SURCMAfiGE <br />PUBLIC WORNS <br />TOTAL <br />. <br />