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--. <br />APPLICATI�N FOR CONSTRUC'� �ON PERMIT �}� <br />CITY OF EVERETT • BUILDING DIVISION (�/���, . <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-BB10 �M ��"" <br />�..� <br />f7 DEMOLITION rl COMBINATION f� BUILDING MECHANICAL I � PLUMBING rl SIGN <br />PROJECTADDRESS . G�y�O� <br />S�l Z �UN��T G/V • �i/Y�� (25 G <br />MRIL ADDR[5$ <br />MAIL ADDiiE55 <br />arv nr r� <br />E['.��C1% �'�SC'O�� <br />arv <br />ARGHITECTORDESIGNER MAILA�O�E55 Gltt 21P PMONE <br />GENEB�LCONTRACTOR MAiL/��RE55 CiTY ]IP PHONE SiATELICENSE� <br />MECNANICALCONiR�CiOR MAILADDRE55 CITV ZIP PIIONE STATELILENSE� <br />FvE�x��FfN �'�. SNC�rM�rRz /la�l ��'�'��r le�Ylr,.l .7,� i�zo� �`�2�iis� E�x'l-,ESiziir7 <br />PWMBINGCONiFACT0f1 MAILADDRE55 CI7V ZIP PNONE STATEUCENSE� <br />WORK AND SOUPRE FOOTAGE <br />PROPO 0 USE OF BU�LDING <br />' �I 17C'VTlht <br />LEGAL DESCRIPiION OF PROPERiY <br />LOT _ BLOCN _ <br />CONSTRUCTION LORN LENDER. ADORE55. TELEPNONE NUM�ER <br />TVPE OF <br />WATER CLOSET <br />CLOTHES WASHE <br />URINAI <br />DRINKING FOUNT� <br />FLOOR DRAIN <br />BACKFLOW PREV <br />SINK (SERVICE — <br />COPIES� <br />ITEM I FEE <br />SUB TOTAL S <br />PFRMI7 5 <br />TOTAL FEE $ � <br />FOR OFFICE USE ONLY: <br />fRONTSETAACH P[Aq iETO�CK SIDESETBPCN <br />USE ZON[ LOT AREA VFCANT SIiE <br />f1YE5 fl NO <br />11EIGHTLIMI7ATI0Y NOOfUW[LLING SIZ[OFOLOGRI <br />UNITS <br />NO OI <br />PIANS <br />IlVES Il NO <br />CIiY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />HEATING SYSTEM: I�GAS ❑ ELECTRIC ❑ _ <br />CONtRCT P[R5, ON � � ONE NO ��� � '� _ � / / � / <br />� �j <br />I HEREBY CERTIFV THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINAN(:�� ^:^`.'FP.NING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEfiEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />CTHER STATE Oti LOCAI LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPIY WITH THE STATE <br />CONTRACTORS LAW 1B27 RCW AND 296200 WAC. <br />,� �-�� ' <br />� . �r = ��- 24- 9� <br />SIGj(ATUP � D4TE <br />Cltt BUSMESS IICENSE N0. <br />NO. TVPE OF FIXTURE OR ITEM FEE <br />A/C — AMNDLG UNITS — H.P. <br />i FORCEDAIRSYSTEMS—B.LU.fijt�A'{¢Q.1 I <br />UNITHEATERS—B.T.U. M <br />RANGE <br />WOOD STOVE <br />METALFIREPLACEi <br />FIREPLACEINSERT <br />GAS FIFEPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />TOTAL 5 <br />v11T $ <br />\L FEE 5 <br />PV N CHECK NU4IUER „ I�EE I R[CEIPT N0. <br />OUILDING <br />PWIAOING <br />MECHANIC�I <br />AOOIPONAI PLAN GM[CK <br />OTHER <br />STATE �UILOING SURGNPAGE <br />P11011C WORN$ <br />TOTAL <br />