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�r r-. <br />APPLICATIOrI FOR CONSTRUCTIdN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />, 3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION �j COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: >/�'� I t�� r � �2 a/ r, FVe hC ��r � �i � <br />�'{/- 0 n <br />__� 1�� �1 Q �f� S� l 4/)'l l� o( Sex �- Jr'�J <br />�I) <br />ER M�L��OnE55 CiTY Im PNONE <br />TEN�NT MAIIMOqF55 GTY 710 P�qNE <br />ARGNITECTORDESIGNEA MARIWDRE55 Gltt ]m PHONE <br />/.�ow'rcPV �OhS%/ /�T %3.^k�'�f� .L�',j%1 �.rs /��S $ 1SY-73/L bl�l•'NE �09Y. <br />GENEMtCANiR�Ci M�IL�DORE55 CiIY AP PIIONE Sf�TEtICENSE� <br />MECN�qIC�LCONTRACTOR AIAII�DDPE55 CITY 2li` PlIONE SGTEUCENSE� <br />PIUMBINGCONTR�CTOR MAI��pppE55 p1Y ZIP PHONE SiRELICENSE� <br />OESC�NlE YNRK ANp SW�RE FppT�GE INVOLVE� <br />/� � %% L t' <br />�7�'4L?L � "�• �l.7.-CA � �GL4,- <br />y�lC.�,C�� �z-a.�,�a ��� <br />PPOPOSEDUS preuiiano /r �� <br />�//' <br />LEGIIL OESCRIPTION Oi PROPEf7TY (SNOWN BEIOW OR �TT11CH iW0 GOMES) <br />�oT � I e�ocic oa..J��= `� ' °` ` � <br />��. �.1 f;�n tr�, <br />PANCElTA1f10. ER <br />�' �'�9 C'c,v o3i aoo��. <br />� �� CONSTRIILTIONIO�VlLENDER,ADDRESS.TELEPNONE MJMSER <br />NO. TYPE OF flICTURE OR ITEM FEE <br />WATER CLOSET {TOILET) <br />BATHTUB n.....w�c� <br />UVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />LAUNDRYTHAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL S <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBALN RE�B SETB�CK SIOESEtB�Ck <br />USE IONE <br />NEIGHT LIMITATION <br />OGLqC��NCY NO( <br />FIRE SPRINKLEP RE( <br />lOT �ftEA <br />NO OF OWEl4NG <br />VNIi$ <br />OGCUPFNT�O�D <br />V�C�Ni SIiE <br />❑YES ❑ NO <br />SIZE OF BIDGRi <br />❑YES ❑ NO <br />� HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />LONT�Cf P[pSpNANO PNONE ND <br />I HEREOY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETNER SPECIFIED HEREIN OR <br />NOT. THE 6RANTING OF A PEHMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTNORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WNICH <br />APpLICATION IS MA�E AND I COMPLY WITH THE STATE <br />CONTRACTORS UW 18.27 RCW AND 296200 WAC. <br />� , <br />, <br />x �)"',—�7-t � ,l�zt-�. l- /- L-. <br />SIGN�TIIRE DRE <br />CITY BUSINESS IICEHSG N0. <br />OFEOUIPMENT <br />FORCED AIR <br />UNIT HEATERS <br />CLOTHESDRYENS <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />MEfAL FIREPLACE! <br />'LACEINSERT <br />FIREPLACE <br />SUBTOTAL f <br />PERMIT S <br />�— TOTAL FEE f� <br />PUNCIIECRNUMPFO fEF AEf.EIPTNO <br />5��7 <br />OUII�ING <br />r�u4pirvG <br />MFf,11�NIC�I. <br />ApDIIION�L PIAN �IIf.GK <br />otnEn <br />STqE OUItOMC SURCIUtlCE <br />CITY OF EVERETT runnc wonK; <br />LOCALSALES <br />TAX CODE IS 9105 7o7AL <br />