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APPLICATIG� FOR CONSTRUCT JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 ��� <br />❑ DEMOUTION ❑ COMBINATION ❑ BUILD'IN(i O MECMANICAL �PLUMBING ❑ SI�iN <br />PROJECT ADDRESS: r— � <br />��%� .SPo/�i�/V�: QQ• a— <br />MIUI MDRE55 <br />zm <br />.�� <br />GENER/�ICONTR�LTOR M4LI�OOilE55 tlTY Z�P PiIONE GUTEIICENSE� <br />MECNAM�CN CON7NACTOii M/JL �DORE55 <br />CAiV ZIP <br />PLUMBMGCONTRIIGTOR Y/JIAWpE55 Qtt IIP PIIONE STATELICEHSEI <br />Gp1TWIGTPRICE OF Wqllf <br />pE W�(Y( ANp SpU�qE FOpiAOE NlVOlVEO <br />urOF o.Tn>57Acc. �m�'+(k ETt <br />Sy57 E7t� � �� � -F�' Z <br />PIIOPOSED USE OF EULONN3 <br />C�07liDO IY1 / A�/ 4 //� <br />t£(UL OESCRIPTION OF PROPERIY (5110VM EEIOW pl �nIiCN <br />�oT eiaGc oF <br />PNICEI TIUf I.D. NUMBER <br />CONS7IIIICTqN lWH LENOER. Md1E55.7ELEP11pE MIMBER <br />. ' PLUIbINO <br />NO. TYPE OF Fl%TURE OR ITEM <br />i WAl'ER CLOSET (TOILEn <br />/O BATHTUB <br />LAVATORV (WASH BASIN) <br />� CMflWFG <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BAqCROW PREVENTERS <br />SINK fSFpVICF — HAR. F7 <br />SUB TOTAI S <br />PERMIT f <br />FOR OFFICE USE ONLY: <br />iFON7 SETBIILN REAR $FTBACk S:DE SETBACN <br />USE ZONE <br />NEIGNT LIMITIITION <br />OLGUPANCY NO (% 5 <br />GiqIIP <br />FlRE SPRINKLER FEO'0 <br />IOT�REA <br />NO OF OWELLING <br />UNIfC <br />RE�iON <br />o�r6 <br />V�C�NT SITE <br />❑YES O M� <br />SIZE OF BLOGR I <br />❑YES ❑ NO <br />CITV OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />NEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONT�CT PERSp1 �NO P11p1E NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WI! L BE CAMPLIED WITH WHETHER SPECIFIED HEREfN OR <br />NOT. THE ORANTIN6 OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STA�E OR LOCAL UW RE6UUTINCi CONSTRUCTION OR TNE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTIiORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WWiK FOR WHICFI <br />APPLICATION IS MADE AND I COMPIV WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />x ,�� 2—Sz-%G <br />SqNRUNE O�TE <br />CITY BUSINESS IICENSE NO <br />FORCED AIR S' <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYI <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />PI�N CIIECN NUIMICR <br />BUIIDING <br />PIUMBING <br />MECH�NIC�I <br />�DDIIIONM. PUN CIIECN <br />on+en <br />ST�IE BURUINC SURCIUpCE <br />ruei �c woAKs <br />TOTAL <br />PEF <br />SUB TOTAL f <br />PERMIT S <br />TOTAL FEE S <br />FEE <br />