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APPLICATIOrr FOR CONSTRUCT�JN i�ERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET � EVERETT, WA 98201 • 259-8810 <br />^� ,. � . . . , <br />f J DEMOLITION �CnM81NAT10N fl BUILDING ❑ MECHANICAL ❑ PLUMBING fl SIGN <br />PROJECj-,(1DDRES� � �„ ._.. � �-or�*r`s� vc s 5 t. <br />ESS <br />cm <br />• .. •. . , . � • � -. � a —� � � .r[�t-r�r � \ - 1— V l'X C�' YtU 9v GY�th P 11 �-I KO 1 � <br />7ENANT MAILAODRE55 C�7y =�p PH�NE 1 <br />� � ' ���bil�_ . I ., <br />ApCMITECTORDE5IGNER Mr11lA0�RE55 CITY ZIP PHONE . „, � <br />AIRIL <br />CITV <br />1 <br />r ,; � �r � � � � �� � �nc.�r ��- rvt�r �-tUJv� 1�Otv1211 `fYOla`��t 1'Co[:�93p <br />ME�HANICRL CONTRACTOR MAII AUDRE55 CITY ZIP —'r pHONE STATE IICENSE 1 <br />.. �.-Jl.hl!'. .ill�:�-, r:.) <br />PLUMBINGCONTR�CTOR MRILADDRESS Cltt 21P PNONE pl{ $TATELICENSEI �; <br />GONTMCT PRICE OF WORK <br />OESCRIBE WO(1K �NO SOUARE FOOTAGE INVOWED <br />—A Q - � 6 5 . <br />��O�V v` - � �/�' /// <br />� <br />�'HOPOSED USE Or .qU0.[VNG <br />�LEGAL DESCiUCiION OF PROPERTV (Slh)WN BELOW OR ATfACH TWO LOPIES� <br />LOT'_.� BLOCK OF_ „ <br />/ e-�'r,'l1 G^P � -� z, 3 <br />��(P. � 'a e <br />P ELTA%LU. BER <br />a-� O�aF�o�{-i`Oo4-oo0� <br />CONSifiUCT10N LOAN LENDER, ADDRE55, TELEPHONE NUMBEfl � <br />NO. TYPF. OF FlICTURE OA ITEM <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />� DISHWASHER <br />LAUNDRY TRAY � <br />� CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN � <br />BACKFLOW PREVENTERS <br />SUB TOTAL $ <br />PEHMIT $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACN REAR SETB�CN <br />� Za� <br />U EZON IOTARE� <br />�- ,ci.i�QaG� � <br />HEI6HTtIMITATION � NO OF DWELLING <br />Z(� UN175 I <br />U <br />HEATING SYSTEM: j�l GAS fl ELECTRIC, fl <br />CONTACT PERSON AND ^hONE N�. <br />_�.:�'e/!'/.�e'�..w� .3�1-OZ61 cxi•3z- <br />I HEREBY� CERTIFY �THAT� I.HAVE RE.40����AND�.EXAMINED �THIS <br />APPLICATION AND KNOW 7HE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF IAWS AND ORDINANCES GOVERNING'THIS TYPE OF <br />WORK YJILL BE COMPLIED WITH WHETF:°R SPECIFIEq HEREIN OR <br />�'� NOL�THE�GRANTINO OF A'PERMIT DOES NOT PRESUME�TO 61VE <br />AUTHORITY TO VIOLATE OR. CANCEL ,THE.;PROVISION �OF,ANY <br />OTHER STATE OR LOCAL LAWAEGUCATINO'CONSTFiUCTION OR�THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTNOR�ZED, BY THE <br />' OWNER OF THIS PROPERTY TO PERFORM THE WORK�FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />G�NTRACTORS LAW 1827 RCW AND 298200 WAC. <br />k, �? _ ` v %52o�%'S <br />SIGNRTURE TE <br />pTY BUSINESS LICENSE NO. <br />NO. TYPE OF EOUIPMEN7 FEE <br />A/C —AMNDLO UNITS — H.P. <br />I FORCED AIR SYSTEMS — B.T.U. M E.A. <br />HEAT F:lMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />. RANGE HOOD <br />/ WATER HEATER <br />WOOD STOVE <br />� METAL FIREPLACE (WOO� BURNING) <br />FIREPLACE INSERT (WOOD BURNING) <br />GAS FIREPLACE <br />GAS HANGE <br />GAS PIPING G'� <br />E%HAUSTFAN <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />^ Ib'� Sj� <br />SIDE iETBRLK PUN <br />VACRNI SIiE FEES <br />�5 f i NO BUILOING <br />�LO�F Lrvw4 � —� <br />Si� G/�2�%GC P���MBMC <br />BnSEM�E�NT MECMANICFL <br />;WES I I NO <br />RDDI110NRL PI.AN CHECK <br />OTNER <br />STATE BUI1014C $URCHMCE <br />CITY OF EVERETT rueuc vr�aa;. <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />� I qErEIPTNO. <br />7 <br />