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APPLICATII�..� FOR CONSTRUC7�N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />;] DEMOLITION ❑ COMBINATION �( BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: v�/ /� '`�I� �� ` � � <br />! <br />OW�IER MNL�Oq1E55 GITY 21P �M�ONE /�ry <br />�Q✓�Oti`X9.2/ ,�AH/7E',e 5420� C%vv� ST �✓r',c'F7T 9F�i'�C'<3 2,�1- 7b// z.5,'�- 5s70 <br />7EwWT MNL�OpiE55 GN I�V PNONE <br />11RCMTECTpiDE51GNER IMRAUdiE55 CITY ZIP FHONE <br />MIJL <br />LIT^ <br />MEqIANIGILCONTRACTOR M�1ILADOHE55 CITY ZIP PNONE STATEUCENSE� <br />VlUL6MGCONTR�CTOR YAILADbilE55 CITY ZIP PHONE STATELICENSE� <br />tFuw oescnrnar oF vnorEnrr la�orrn ee <br />ior 'x- e�ocK �0-� <br />7i�iiai�zo <br />CONS1RUCl10N LWN lEN0ER.11DOFE5S. TELEPIqNE NUMBEN <br />�V�� <br />NO. TYPE OF flXTURE OR ITEM FEE <br />WATER CLOSET (TOILEn <br />2 BATFITUB <br />LAVATORY(WASH BASIN) <br />2 SHOWER <br />KRCMEN SINK 8 DISP <br />DISHWASHER <br />UUNDRY TMY <br />CLOTHES WASHEH <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />9ACKFLOW PREVENTERS <br />SUB <br />� TOTAL F <br />FOR OFFICE USE ONLY: <br />FHON! SETBACK / REAR SET�(',N ��� <br />�C� <br />USE ZONE D ^ LOT ARI� �,�� � <br />.� \ <br />HEI6HTLIMITATION+ / I IUINOIf�DWELUNG <br />ii�r <br />a <br />O�TE <br />S I � � <br />S ' <br />SIDE SETB�CN / <br />VACANI�� <br />❑vE5 ❑ NO <br />OF &DNf I <br />46 SF. G � � <br />BASEGEN <br />S <br />ES C N� <br />HEATING SYSTEM: I� GAS O ELECTRIC ❑ <br />CONT�CT PERSON AND VHONE <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINEO THIS <br />APPLICATION AND NNOW 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 ORANTIN6 OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHEH STATE OR LOCAL LAW REGULATINO CANSTRUCTION OR THE <br />PERFORMANCE OF CANSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORI( FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTO 8.2�296200WAC. <br />x � cC/—%(o <br />$�(yy�TURF DATE " <br />CITY BUSWE55 LICENSE NO. <br />NO. T1IPE OF ECU <br />NC — AMNDL(i UNIiS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CI.OTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />MEfAL FIREPLACE (WOf <br />FIREPLACE INSEFiT (WO <br />GAS FIREPLACE // <br />GAS RANGE <br />PERMIT f <br />TOTALFEE S <br />PI�N CIIECK NUGBER FEF AECEIPT NO <br />. �/%S2 �i��o <br />BWIDINC <br />PIUMBING — <br />MECM�NIUL <br />RDpTION�L �LAN GHF.CN <br />OTHER <br />$TAIE BUILOING $URCN�RGE <br />CRY OF EVERE7T �ueur, woaKs <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />