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APPLICATION FOR CONSTRUCT�ON PERMIT <br />CITY OF EVERETT• BUILDING DIVI510N <br />3200 CEDAR STR�ET + EVERET7', �l�lq 88201 � 259-8810 <br />�. <br />L7 DEMOUTION COMBI�IATION f7 BUILDIItiG Cl MECHANICAL f7 PLUMBING (-I SIGN <br />PROJECT ADDRESS ���D i �+-�aM� <br />- W� nf 13� Ave r.o on `l�e �7/� sic�e c� 55�'n s�srn�. 13�5' .55��- V.� <br />uut�oonEss � ciT• <br />1(� 1R'Q1� 1�..�c11_G..,.,-. <br />AACMfTEC10ROE51GNEfl MAItA00RE55 CI7Y IIP PMONE <br />I .. <br />r,. , <br />Pl1iA1BWGCONTR�CTOR M�IIADDRE55 � � <br />��TY 1�P PHONE STATELICENSEI , <br />CONTR�CT PFYCE OF WOqK /��" � — <br />�7�p� HEATING SYSTEM: GAS fl EIECTRIC fl' '' <br />DESCRIBEWOpK�N(1 ApEi00TAG INVOLVED CONT CTP $OY�NDPIIONEN . <br />J 2 - - L,�.r- ?/� —02 � / e�ri3'2 <br />� <br />XLEGAL UESLWPTIpry OF PflOPI <br />�oT as B�� <br />no. rne oF Flx <br />� WATER CLOSET(TOI <br />� <br />enTMrue <br />UVATORY (WASH Bl <br />� SHOWER <br />1 KfTCHEN SINK d UISI <br />DISHWASHEq <br />IAUNORYTRAY <br />CLOTHES WASHER <br />URINAL <br />pRINKINQ FOUNTAIN <br />FLOOq DRAIN <br />BACKFLOW PREVEN' <br />SINK /SERVICE — BA <br />ATTACN <br />TELEPHONE <br />I HEREBY CEF�jIFY�.THAT 1 HAVE READ AND EXAMINED THIS <br />�—�— APPLICATION AND KNOW THE SAME 7U BE TRUEANO CORRECL ALL <br />PROVISIONS OF LAWS ANp ORDINANCES GO /EjiNINQ Tjjl$ TYPE OF <br />WORK WILL BE COMPLIED yyITH WHETHER ':;PECIFIEq H�REIN OR <br />NOT. THE ORAryTINa OF A PERMIT pOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE �OR CANCEL THE PROVI§IOry'..OF ANY <br />Y OTHER STATE Oq LOCAL LAVy REOULqTINO CON57jiUCTION �R 1 HE <br />PERPORMANCE OF CONSTRUCTION. THAT I AM AUTF10iiIZED BY THE <br />OWNER aF THIS PROPERTY TO pERFORM THE WORK FOR. WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STAT� <br />CONTRACTORS LAW 18.27 RCW AND 296200 WqC. <br />wNATURE v 9 z f95' <br />CIT7 pUSINESS IICENSE NO. <br />OR ITEM � FEE <br />SUBTOTAL E <br />PERMIT $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAq S^E�TBACN <br />� ^ CO <br />USE�'� IOTRRF��� <br />C�w1T_ <br />HEIGMTLIMITATIO NOOF�WEIIING <br />2 � � UNIiS ' <br />Z <br />OFf,ONST <br />�'/✓ <br />unie <br />!� <br />51[lE SETBaGN <br />J <br />V�CFNf �SIIE <br />ATYES I i N/l <br />TYPE OF EQUIpMENT I FEE <br />n/v�Nl'IryULV VIYI15—�{.Y <br />FURCE� AIR SYSTEMS — B.T.U. M E.A. <br />HEAT pUMP <br />UNIT HEATERS — B.T.U. M <br />CtOTHES DRYERS <br />VENTI�4T'ION FAN <br />WOOD STOVE <br />FIHEPLACEINSERT <br />GAS FIREPLACE <br />�AS R 4VGE <br />GAS PIPIN� <br />TOTAL Z <br />FEE E <br />PLAN CUECK y11MBEq „ � FEE _ , y-� I AECEIPT NO. <br />61111DING <br />'IiE OF BIOGRI <br />1 �) S�F G.I�/i� } p�pMBIN6 <br />s GAr E <br />BASEMENT MECM�NIC�t <br />f1YE5 yYIO <br />—` A�DIIION�LPUNCHf:f.N <br />OTIIEfl <br />STATE BUIIDING SIIApIn(iCE <br />CITY OF EVERETT ruenc wonKs <br />LOCALSALES <br />TAX CODE !S 3105 70TAL <br />i i� J <br />'r— <br />i <br />, )�c � ; C'�cl <br />� !�) <br />