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� <br />APPLICATIOh FOR CONSTRUCTItiN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOUTION � COMBINATION O BUILDING ❑ MECHANICAL ❑ pLUMBING ❑ SIGN <br />PROJECTADDRESS:_ .'� � �i- 50 �H JT. _S,(,✓ <br />Mfi/�i c s-.�. N/-� c/S, �i� � t �t_ ,, sS �,o c,., �� <br />7ENANT <br />IIP <br />gLoi 38&-qc6o <br />ARCNITECTOROESIGNER MAIIADDRE55 CITY 71P Pl10NE <br />GENEMICONTMCTOR MAIL�DDRE55 �ITY SiP PnONE $IATEIICENSE� <br />f✓Hc6!+�tl CDrSl' ti � 3L fll�ilf �-9'-0 9c� E G�/' � 9 BGo� L S2-7Yw NA�Bq� �z3��fi <br />MECNANICKCONTR�CTOR MAI�ADONE55 CIN ZIP PIIONE STATEIiCENSEr <br />PLUM8ING CONTRA�7pq MAIL AODRE55 CITY ZIP pHONE STATE UCENSE � <br />I%FlV�SSFK���i: PLL�yBI/JI 3YiiKR�,�,Fj� <�f/z�n" 98L�� z59-L9gv P�v�SS,F//65JQkc <br />CONTMCT PPoCE OF Y/ORK I%O �O ' . <br />� HEATING SYSTEM: ❑ GAS C?7'ELECTRIC O <br />OESGN�BE WORNANO SOUARE FOOTAGE INVOIVED CONTACT PlHSONAND PHONE NO <br />R�' Runl•' � t� I(J,,..i-fi1 /`�FW ���F,O/rG f�A`'T`U/�Gf LA/<iY/✓/i tlf0�i� zS t' � Y�o <br />�t <br />USEOFBUILDIN(i � <br />�kS�o <br />NL•✓ <br />LEGIIL DE,SCH/IPTION OF PRppEPTY fSHOWN BELOW OR ARACH <br />� LOT � BLOCN OF V� Fl.i F+ <br />p��i Sr �i� � 3 <br />� PAHCELTA%I.D. MBEH <br />�7C� 4 £L�.b �� <br />CONSiHULT10N LOAN LENDER. AODRE55. TELEPHONE NUMBEN <br />N�/� <br />PLUMBINO <br />TYPE OF FlXTURE <br />WATER CLOSET ROILETI <br />SHOWER <br />KITCHEN SINK 6 DISP <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAI <br />BACKFLOW <br />FOR OFFICE USE ONLY: <br />FRONT $ETBACK REAq SETBACK <br />USE20NE <br />NEIGHT LIMITATION <br />LOTAqEA <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />SIDE SETB�CN <br />NO.OF DWELLING <br />UNIfS <br />REASON <br />o�Te <br />FEE <br />VAC�NT SIfE <br />❑YES ❑ NO <br />SIZE OF BLDC/f.l <br />BASEMENT <br />❑vE5 ❑ NO <br />I HEREBY CERTIFY 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 ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT �OES N01' PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROJISION OF ANY <br />OTHER STATE OR LOCA� LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM TME WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPIy WITH THE STATE <br />CONTRACTORS LAW 18.27 HCW AND 296200 WAC. <br />x 7�—,��-ze�-.1 �%��=�-z� '7 1 L r/9 � <br />SIGN� URE DATE <br />CITY BUSINE55 LICENSE NO. <br />OP E�UIPMENT � FEE <br />iUNRS <br />; FORCED AIF SYSTEMS � <br />� HEAT PUMP , <br />' UNIT HEATERS � <br />i CLOTHES DRVERS � <br />! RANGE HOOD —� <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />WOOD STOVE <br />METAL FIREPLACE <br />GAS FIREPLACE <br />GAS PIPING <br />PIAN CHECK NIIMBER <br />BUIIUING <br />PLUMpING <br />MECHANICAL <br />RDDITIONAI. �L�N C��F.CK <br />OTHEA <br />STATE BUILOING SUpCHMCE <br />rueur, wonKs <br />TOTAL <br />SUB TOTAI S <br />PERMIT E <br />TOTAL FEE E <br />FEF � REf.EIPT NO. <br />i <br />