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APPLICATION FOR CONSTRUC? �ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION �M8INATION �i" BUILDING Cl MECHANICAL rr�LUM8ING f l SIGN <br />PROJECT ADDRESS <br />mni�nWNG55 CITY ZIP PMONE <br />SERR�i rA�M�.s 3ocy9 SlST�� SW . EvT 9$1.03 3 Y7-4'1 sg <br />TENAN^T Q MAllR00RF55 CITY ZIP PNONE <br />S T �.•` <br />C Cn MMILqUU <br />CL�/D� Aq��uD <br />GENE RLCO,^�TRAGTOR MAILA�OI <br />�Av�F�ANSO,v /O <br />MECHANICALCONTRACTOR MRILADDI <br />� Vg. ��T� � � �Z <br />PLbMB GCONTRAGTOR MAI�A�01 <br />wor+K nNo <br />C <br />LEGAL DESCRIPTION OF PRCPERTV <br />�or �^ e�ocK _ <br />B�Crr4R0 +k5'Dh <br />l:I1T <br />� ]-�- s . 3Rn 1��� '�i <br />�i.Y <br />� �/. P�R� �P �, �� <br />� CIIY <br />ra <br />cin <br />11 <br />/ED ^ <br />��< <br />DON �-`LO <br />Y <br />PMCEL TA% 1 D. NUMBER <br />l� �9 c� �v2 -ca�� <br />CONSTRUCTIONIOANIENDER,ADDRESS,TELEYHONENUMBER <br />SE�F i^�NAu� ED <br />NO. TYPE OF flXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DF;AIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ETC.I <br />TWO COPIES) <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETflACK � /f pEAP $ETBRCK_ <br />ii� �:' <br />C <br />USE ZONE //n� /1 LOi r1REA <br />— /�'�•j <br />NEIGHTLIMIT�Aj`ON� � NOOFDWELLING <br />��� UNifi <br />OCCUPANCY NO 0� $10PiES OCCUPANT 104D <br />RFASON <br />FIRF. <br />TYPE OF CONST <br />SIOE SETfiRCN <br />��T,9B�-o3 �Sz-`d37� <br />ZIP F.ipNE STA1E LICENSE � <br />g'i�i'�03 �s9%9Sb DAvEHcND�72N <br />1�� PHONE STATEUf.ENSE+ <br />PHONE STATE LICEtlSE • <br />HEATING SYSTEM: �fGAS �7 ELECTRIC f-1 <br />CONTFCT PEPSON ANO PNONE NO <br />I HEREBY CERTiFY THAT I HAVE READ AVD EXAMINED THIS <br />APPUCATION 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 DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAI LAW REGULATING 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 />APPLIC TION IS MADE AND :�OMPLY WITH THE STATE <br />CONT URS LAW 7827 RCW AN � 96.200 WAC. <br />X-�. / <br />. a- -� <br />SIGNFTURE DATE <br />CItY BUSINE55 UCENSE NO. <br />NO. TYPE OF EOUIPMENT FEE <br />rvu—wnnuW urv113—H.Y. <br />FORCED AIR SYSTEMS — B.T.U. M C.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />`NATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE i <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL $ <br />PERMIT $ <br />PLANCIIEh�%�/,� I fEF O I FECEIPTNO. <br />//q � <br />VpG^N7 $ITE FEE& <br />f 1 VE: f i NO BUII�MG <br />JF BLDGRI <br />o SF G!v�✓4 f rwrnoiNc <br />Z SF Gw RAc.: <br />BRSEME�NT MECNlNILAL <br />(NES (I NO <br />ADDIIIONAL P14N CNCCN <br />Oi11EP <br />STNE BUII�ING SURf,1��RGE <br />CITYOFEVERETT rueiicwonKs <br />LOCAL SALES <br />TAX CODE IS 3105 7o7AL <br />2 <br />